Active NPI
Dimitria Elise Jackson
- Specialist
- Oakland, CA
National Provider Identifier
1679758478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 6955 Foothill Blvd.
Suite 300
Oakland, CA 94605-2421 - Phone
- (510) 577-1906
- Fax
- (510) 577-5618
- NPI assigned
- Dec 31, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
6955 Foothill Blvd.
Suite 300
Oakland, CA 94605-2421
Mailing address
6955 Foothill Blvd.
Suite 300
Oakland, CA 94605-2421
Phone (510) 577-1906
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Alameda Behavioral Health Care | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Public Health or Welfare Agency
- Oakland, CA
- NPI 1043489859
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199059200000",
"number": "1679758478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6955 FOOTHILL BLVD.",
"address_2": "SUITE 300",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946052421",
"telephone_number": "510-577-1906",
"fax_number": "510-577-5618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6955 FOOTHILL BLVD.",
"address_2": "SUITE 300",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946052421",
"telephone_number": "510-577-1906",
"fax_number": "510-577-5618"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DIMITRIA",
"middle_name": "ELISE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-31",
"last_updated": "2007-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.