Mary Lueben Jackson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

C0003990 Issued in MD

Practice address

9000 Franklin Square Dr
Baltimore, MD 21237-3901

Phone

(443) 777-7046

NPI assigned

Jun 23, 2009

Last updated

Jan 2, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Jesse Lueben Former name

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

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 2

Merit-based Incentive Payment System (MIPS)

Final score

94.27 of 100Reported as group

Quality

80.29

Promoting interoperability

100

Improvement activities

40

Cost

75.48

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Medstar Medical Group II LLC

  • General Practice Physician
  • Baltimore, MD
  • NPI 1184046187

  DC

  Medicare reassignment NPD
• Medstar Urgent Care LLC

  dba MedStar PromptCare

  • Urgent Care Clinic/Center
  • Baltimore, MD
  • NPI 1902175870
  Medicare reassignment
• WHC Physician Group LLC

  • General Practice Physician
  • Washington, DC
  • NPI 1700154226

  MD

  Medicare reassignment
• Medstar Urgent Care LLC

  • General Practice Physician
  • Lexington Park, MD
  • NPI 1275410474
  NPD
• Medstar Urgent Care, LLC

  dba MedStar PromptCare-Wheaton

  • Urgent Care Clinic/Center
  • Wheaton, MD
  • NPI 1871843409
  NPD
• Medstar Medical Group II LLC

  • Hospitalist Physician
  • Washington, DC
  • NPI 1770198301
  NPD
• WHC Emerg Phys

  • Emergency Medical Services (Emergency Medicine) Physician
  • Washington, DC
  • NPI 1306260625
  NPD
• WHC Physician Group LLC

  • Psychiatry Physician
  • Washington, DC
  • NPI 1477996858
  NPD
• Medlantic Healthcare Group

  • Emergency Medicine Physician
  • Baltimore, MD
  • NPI 1467408450
  NPD (past)

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

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420156800000",
    "number": "1720216203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 FRANKLIN SQUARE DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212373901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 FRANKLIN SQUARE DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212373901",
            "telephone_number": "443-777-7046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "middle_name": "LUEBEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-23",
        "last_updated": "2015-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0003990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "LUEBEN",
            "middle_name": "JESSE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lisa Wilhelm Jackson, MS, RD, LDN, CNSC
• Marcella Jackson, LMSW
• Mariah M Jackson
• Marie C Jackson
• Mark Jackson, MD
• Matthew Jackson, D.O.
• Matthew Jackson, MD
• Mia Jackson
• Miraya Jackson, LMSW
• Montess Thorne Jackson

• Medical Physician Assistant in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2015; 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.