Individual provider Active NPI

Dustin J Jackson, M.D.

  • Anesthesiology Physician
  • Canonsburg, PA
National Provider Identifier
1689807679
Registry record updated Nov 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD448804 Issued in PA
Practice address
100 Medical Blvd
Canonsburg, PA 15317-9762
Phone
(412) 359-3155
Fax
(412) 359-3483
NPI assigned
Aug 25, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD448804 PA Primary

Addresses

Primary practice location

100 Medical Blvd
Canonsburg, PA 15317-9762

Mailing address

320 E North Ave
Pittsburgh, PA 15212-4756
Phone (412) 359-6581

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address djackson133153@direct.ahn.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130903000422 PA Practitioner - Anesthesiology 5193968600 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Pennsylvania State University College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allegheny ClinicGroup PAC ID 5395649586, 2,313 clinicians

Practice addresses (Care Compare)

100 Medical Blvd
Canonsburg, PA 15317-9762
Phone (724) 745-6100

Hospital & facility affiliations

  • Ahn Wexford Hospital Hospital, Wexford, PA, CCN 390334

Merit-based Incentive Payment System (MIPS)

Final score
93.9 of 100Reported as apm
Quality
85.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD448804PAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Allegheny Clinic Anesthesiology CurrentSince Jun 5, 2017 Accepting new patients
Allegheny Clinic Current Accepting new patients
Allegheny Clinic CurrentSince Jun 5, 2017 Accepting new patients

Locations

100 Medical Blvd
Canonsburg, PA 15317
Phone (412) 359-4138

1301 Carlisle St
Natrona Hts, PA 15065
Phone (724) 224-5100

320 E North Ave
Pittsburgh, PA 15212
Phone (412) 359-3131

12351 Perry Hwy
Wexford, PA 15090
Phone (412) 359-3030

Interoperability endpoints

  • Direct secure messaging: djackson@direct.excelahealth.org

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1251158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668816000000",
    "number": "1689807679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 E NORTH AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152124756",
            "telephone_number": "412-359-6581",
            "fax_number": "412-359-3483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL BLVD",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153179762",
            "telephone_number": "412-359-3155",
            "fax_number": "412-359-3483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DUSTIN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-25",
        "last_updated": "2022-11-19",
        "certification_date": "2022-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD448804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "djackson133153@direct.ahn.org",
            "affiliation": "N",
            "address_1": "320 E North Ave",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152124756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Canonsburg, PA

Sources for this page

Verify at the official NPI Registry.