Edwin Jackson, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME 87406 Issued in FL

Practice address

4010 Central Ave
St Petersburg, FL 33711-1239

Phone

(727) 327-7656

Fax

(727) 388-1192

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Psychiatry

Education

University of Tennessee, HSC, College of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baycare Behavioral Health IncGroup PAC ID 4688649122, 58 clinicians

Behavioral Health Management Services, IncGroup PAC ID 1456262450, 34 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: edwin.jacksonmd@direct.mybaycare.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.

• Baycare Behavioral Health Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New Port Richey, FL
  • NPI 1225312549
  Medicare reassignment Care Compare group NPD
• Behavioral Health Management Services, Inc.

  dba BayCare Life Management

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Clearwater, FL
  • NPI 1417052713
  Medicare reassignment Care Compare group NPD
• Baycare Behavioral Health Associates LLC

  • Psychiatry Physician
  • Lutz, FL
  • NPI 1245502152
  Medicare reassignment NPD
• Winter Haven Hospital Inc

  • General Acute Care Hospital
  • Winter Haven, FL
  • NPI 1477599975
  Medicare reassignment NPD
• Baycare Behavioral Health Associates LLC

  • Psychiatry Physician
  • Clearwater, FL
  • NPI 1952856858
  NPD
• Baycare Behavioral Health Inc.

  dba Harbor

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New Port Richey, FL
  • NPI 1508864521
  NPD

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318204800000",
    "number": "1740294883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4024 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337111239",
            "telephone_number": "727-327-7656",
            "fax_number": "727-388-1192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337111239",
            "telephone_number": "727-327-7656",
            "fax_number": "727-388-1192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EDWIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2011-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME 87406",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME 87406",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA HEALTH PARTNERS",
            "identifier": "F01714",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Jackson Jr.
• Christopher L Jackson, PHD, DOM, AP
• Debra E Jackson, ARNP
• Deja Jackson
• Ebony Denashia Jackson, REGISTERED NURSE
• Janice P Jackson, ARNP
• Jennifer Brockman Jackson, OTR
• Joseph C Jackson Jr., DDS,PA
• Keyana Marie Jackson
• Larry Jackson

• Psychiatry Physician in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.