Wayne Jeffery Jackson, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

004496 Issued in NY

Practice address

50 Leroy St
Potsdam, NY 13676-1786

Phone

(315) 265-3300

NPI assigned

Jun 22, 2005

Last updated

Mar 31, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Canton-Potsdam Hospital

  • General Acute Care Hospital
  • Potsdam, NY
  • NPI 1568548782
  Medicare reassignment NPD
• Gouverneur Hospital

  • Critical Access Hospital
  • Gouverneur, NY
  • NPI 1629409925
  Medicare reassignment NPD
• Delphi Healthcare PLLC

  • Emergency Medicine Physician
  • Rochester, NY
  • NPI 1003075029
  Medicare reassignment
• Delphi Hospitalist Services LLC

  • Hospitalist Physician
  • Rochester, NY
  • NPI 1922270420
  Medicare reassignment
• Emergency Physician Services of New York, P.C.

  • Emergency Medicine Physician
  • Poughkeepsie, NY
  • NPI 1093759847
  Medicare reassignment
• Gouverneur Hospital

  dba Gouverneur Hospital, Inc. Medical Professional Group

  • Critical Access Hospital
  • Gouverneur, NY
  • NPI 1295156412
  Medicare reassignment
• River Hospital, Inc.

  • Critical Access Hospital
  • Alexandria Bay, NY
  • NPI 1003814641
  Medicare reassignment
• Canton-Potsdam Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Potsdam, NY
  • NPI 1114104445
  NPD
• Canton Potsdam Hospital

  • Physical Therapy Clinic/Center
  • Canton, NY
  • NPI 1770703522
  NPD (past)
• North Country Emergency Medical Consultants,PC

  • Emergency Medicine Physician
  • Watertown, NY
  • NPI 1972572295
  NPD (past)

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1750387023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 LEROY ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761786",
            "telephone_number": "315-265-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 LEROY ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761786",
            "telephone_number": "315-265-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 Fuller Street",
            "address_2": "River Hospital",
            "address_purpose": "LOCATION",
            "city": "Alexandria Bay",
            "state": "NY",
            "postal_code": "13607",
            "country_code": "US",
            "telephone_number": "315-482-2511",
            "fax_number": "315-482-4981",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "WAYNE",
        "middle_name": "JEFFERY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "004496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey M Howlett
• James Huang, M.D.
• Emily Hunt
• Atif Suhail Iqbal, M.D.
• Nadine Marie Irvine, RN
• Jubin Jacob, MD
• James Huang Physician PLLC (Potsdam Anesthesia Associates)
• Eboni Christina January, M.D.
• Amber Jarrett, R.N.
• Matthew Clark Jenison, ACNP

• Medical Physician Assistant in Potsdam, NY
• Providers in Potsdam, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.