Calvin R Jackson

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

031265 Issued in GA

Practice address

2123 Wrightsboro Rd
Augusta, GA 30904-4777

Phone

(706) 736-5244

Fax

(706) 736-5246

NPI assigned

Aug 25, 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 2

Medicare fee-for-service enrollment

Enrolled in GA, SC2 enrollments

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 2

Specialty

Internal Medicine

Education

Medical University of South Carolina College of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beulah Grove Community Resource CenterGroup PAC ID 3779471743, 4 clinicians

Medical Office ForceGroup PAC ID 9335481951, 58 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Home Health Home health agency, Martinez, GA, CCN 117025
• Piedmont Augusta Hospital Hospital, Augusta, GA, CCN 110028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: calvinjackson@csrama.allscriptsdirect.net

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.

• Beulah Grove Community Resource Center

  • Primary Care Clinic/Center
  • Augusta, GA
  • NPI 1558544684

  GA

  Medicare reassignment Care Compare group NPD
• Medical Office Force

  • Internal Medicine Physician
  • Athens, GA
  • NPI 1508378613

  GA

  Medicare reassignment Care Compare group
• Csra Medical Associates

  • Internal Medicine Physician
  • Augusta, GA
  • NPI 1164530689

  GA, Internal Medicine, SC

  Medicare reassignment NPD
• Palmetto Infusion Services LLC

  • Infusion Therapy Clinic/Center
  • West Columbia, SC
  • NPI 1265462659
  NPD (past)
• Winyah Home Health Care, LLC

  • Home Health Agency
  • West Columbia, SC
  • NPI 1003227331
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Augusta Home Care Services, LLC

  • Home Health Agency
  • Martinez, GA
  • NPI 1174991038
  Care Compare affiliation
• University Health Services,Inc

  • General Acute Care Hospital
  • Augusta, GA
  • NPI 1588665566

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206662400000",
    "number": "1740398338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2123 WRIGHTSBORO RD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309044777",
            "telephone_number": "706-736-5244",
            "fax_number": "706-736-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2123 WRIGHTSBORO RD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309044777",
            "telephone_number": "706-736-5244",
            "fax_number": "706-736-5246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CALVIN",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2008-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "031265",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "16449",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000623796B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164495",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Isaac Jacks, MD
• Jackson Forensic Psychiatry LLC
• Jackson Mobility Solutions, LLC
• Amanda Bryans Jackson, DMD
• Anna Loyal Jackson, M.D.
• Catherine Jackson
• Charlene Dawn Jackson, RKT
• Christine Jackson, RN
• Elizabeth Jackson
• Fatima D Jackson

• All providers in Augusta, GA
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; 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.