Autumn A Jackson, MHS, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

C0003077 Issued in MD

Practice address

3300 Gallows Rd
Inova Fairfax Ed
Falls Church, VA 22042-3307

Phone

(703) 776-2690

NPI assigned

May 23, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Autumn A McKenzie Former name

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

83.31 of 100Reported as group

Quality

73.89

Promoting interoperability

100

Improvement activities

40

Cost

70.47

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ajackson49237@direct.hopkinsmedicine.org

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.

• Johns Hopkins University

  • Pain Medicine (Anesthesiology) Physician
  • Baltimore, MD
  • NPI 1922008549

  MD

  Medicare reassignment
• Johns Hopkins University

  • Ophthalmology Physician
  • Belcamp, MD
  • NPI 1376342774
  NPD
• Johns Hopkins University

  • Emergency Medicine Physician
  • Baltimore, MD
  • NPI 1386631810
  NPD
• Bestpractices, Inc.

  • Emergency Medicine Physician
  • Falls Church, VA
  • NPI 1639177942
  NPD (past)
• Bestpractices, Inc.

  • Emergency Medicine Physician
  • Woodbridge, VA
  • NPI 1730180944
  NPD (past)
• Eastern Carolina Ear Nose and Throat Associates PA

  • Otolaryngology/Facial Plastic Surgery Physician
  • Smithfield, NC
  • NPI 1831153402
  NPD (past)
• Evolve Medical Spa PLLC

  • Multi-Specialty Clinic/Center
  • Smithfield, NC
  • NPI 1194140129
  NPD (past)
• Icem, LLC

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1467788208
  NPD (past)
• Joseph S. Fastow, M.D., P.a.

  • Critical Access Hospital
  • Prince Frederick, MD
  • NPI 1861443103
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310342400000",
    "number": "1689629099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7832 TILGHMAN ST",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592579",
            "telephone_number": "202-276-8671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 GALLOWS RD",
            "address_2": "INOVA FAIRFAX ED",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220423307",
            "telephone_number": "703-776-2690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AUTUMN",
        "middle_name": "A",
        "credential": "MHS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2011-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0003077",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002073",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUTUMN",
            "last_name": "MCKENZIE",
            "middle_name": "A",
            "credential": "MHS, PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Valerie Denise Jackson, PHARMACIST
• Ann Jacob, DO
• Elizabeth Renee Jacobs, HIS

• All providers in Falls Church, VA
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.