NPIMap

Individual provider Active NPI

Kristina G Jackson, M.D.

  • Family Medicine Physician
  • Danvers, MA
National Provider Identifier
1740350586
Registry record updated Oct 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
75394 Issued in MA
Practice address
480 Maple St
Danvers, MA 01923
Phone
(978) 887-3675
Fax
(978) 887-5097
NPI assigned
Nov 9, 2006
Last updated
Oct 1, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 75394 MA Primary

Addresses

Primary practice location

480 Maple St
Danvers, MA 01923

Mailing address

480 Maple Street
Suite 204
Danvers, MA 01923
Phone (978) 887-3675

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20050412000308 MA Practitioner - Family Practice 9032156039 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Massachusetts Medical School, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

15 Railroad Ave
South Hamilton, MA 01982-2218
Phone (978) 468-7381

480 Maple St
Danvers, MA 01923-4065
Phone (978) 304-8380

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.98 of 100Reported as apm
Quality
76.59
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
75394MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beth Israel Lahey Health Specialty Care, Inc. CurrentSince Dec 1, 2007 Accepting new patients
Beth Israel Lahey Health Primary Care, Inc. Family Medicine CurrentSince Oct 10, 2024 Accepting new patients
Beth Israel Lahey Health Primary Care Inc CurrentSince Oct 10, 2024 Accepting new patients
Beth Israel Lahey Health Primary Care, Inc. Past Accepting new patients

Locations

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400

480 Maple St
Danvers, MA 01923
Phone (978) 304-8380

480 Maple St
#204
Danvers, MA 01923

480 Maple St
Ste 204
Danvers, MA 01923
Phone (978) 304-8370

15 Railroad Ave
South Hamilton, MA 01982
Phone (978) 468-7381

16 S Main St
Topsfield, MA 01983
Phone (978) 887-3675

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10729/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kjackson31503@direct.bilh.masshiway.net

Organizations & group practices 4

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 9

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": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380585600000",
    "number": "1740350586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 MAPLE STREET",
            "address_2": "SUITE 204",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "01923",
            "telephone_number": "978-887-3675",
            "fax_number": "978-887-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 MAPLE ST",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "01923",
            "telephone_number": "978-887-3675",
            "fax_number": "978-887-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTINA",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2013-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "75394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danvers, MA

Sources for this page

Verify at the official NPI Registry.