NPIMap

Individual provider Active NPI

Rebecca T Jackson, MD

  • Internal Medicine Physician
  • Knoxville, TN
National Provider Identifier
1689610628
Registry record updated May 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
28584 Issued in TN
Practice address
10215 Kingston Pike
Ste 100
Knoxville, TN 37922-3222
Phone
(865) 691-0733
NPI assigned
Jun 20, 2006
Last updated
May 7, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 28584 TN Primary

Addresses

Primary practice location

10215 Kingston Pike
Ste 100
Knoxville, TN 37922-3222

Mailing address

1225 E Weisgarber Rd
Suite 200
Knoxville, TN 37909-2604
Phone (865) 584-4747

Other identifiers 2

IdentifierTypeStateIssuer
3807952MedicaidTN
110136878OtherTNRR MEDICARE PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100223000293 TN Practitioner - Internal Medicine 5799829131 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Georgia School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group, PLLCGroup PAC ID 2860396330, 636 clinicians
Champion Physical Therapy LLC HallsGroup PAC ID 1355416306, shared by 4 NPIs, 277 clinicians

Practice addresses (Care Compare)

10215 Kingston Pike
Suite 100
Knoxville, TN 37922-3492
Phone (865) 691-0733

103 Midlake Dr Level
Knoxville, TN 37918-3039
Phone (865) 687-7704

121 N Calderwood St
Alcoa, TN 37701-2109
Phone (865) 336-9188

1225 E Weisgarber Rd
Suite 200
Knoxville, TN 37849-4016
Phone (865) 938-3627

1275 Dick Lonas Rd
Knoxville, TN 37909-1326

201 E Emory Rd
Powell, TN 37849-4016
Phone (865) 938-3627

7211 Wellington Dr
Knoxville, TN 37919-5968

9333 Park W Blvd
Knoxville, TN 37923-4305

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, PLLC CurrentSince Jan 15, 1997 Accepting new patients
Summit Medical Group, PLLC Internal Medicine CurrentSince Jan 15, 1997 Accepting new patients
Summit Medical Group, PLLC Internal Medicine Past Accepting new patients

Locations

10215 Kingston Pike
Ste 100
Knoxville, TN 37922
Phone (865) 691-0733

1225 E Weisgarber Rd
Ste 200
Knoxville, TN 37909
Phone (865) 938-3627

Interoperability endpoints

  • Direct secure messaging: rebecca.jackson.1@20785.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210118400000",
    "number": "1689610628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 E WEISGARBER RD",
            "address_2": "SUITE 200",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092604",
            "telephone_number": "865-584-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10215 KINGSTON PIKE",
            "address_2": "STE 100",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379223222",
            "telephone_number": "865-691-0733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "REBECCA",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-20",
        "last_updated": "2008-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "28584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3807952",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "110136878",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.