NPIMap

Organization Active NPI

Bernice D Jackson MD Cardiology Services, PLLC

  • Cardiovascular Disease Physician
  • Washington, DC
National Provider Identifier
1750548657
Registry record updated Jul 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD17118 Issued in DC
Legal business name
BERNICE D JACKSON MD CARDIOLOGY SERVICES, PLLC
Practice address
1160 Varnum St NE
Suite 314
Washington, DC 20017-2107
Phone
(202) 269-9249
Fax
(202) 269-9271
NPI assigned
May 19, 2008
Last updated
Jul 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2008

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

Authorized official

Name
Dr. Bernice D. Jackson, MDNPI 1639195407
Title
President
Phone
(202) 269-9249

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD17118 DC Primary

Addresses

Primary practice location

1160 Varnum St NE
Suite 314
Washington, DC 20017-2107

Mailing address

1160 Varnum St NE
Suite 314
Washington, DC 20017-2107
Phone (202) 269-9249

Other identifiers 2

IdentifierTypeStateIssuer
1639195407OtherDCNPI INDIVIDUAL
027063100MedicaidDC

National Provider Directory

National Provider Directory

Locations

1160 Varnum St NE
Ste 314
Washington, DC 20017
Phone (202) 269-9249

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1750548657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 VARNUM ST NE",
            "address_2": "SUITE 314",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172107",
            "telephone_number": "202-269-9249",
            "fax_number": "202-269-9271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 VARNUM ST NE",
            "address_2": "SUITE 314",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172107",
            "telephone_number": "202-269-9249",
            "fax_number": "202-269-9271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERNICE D JACKSON MD CARDIOLOGY SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BERNICE",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "202-269-9249",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "DC",
            "license": "MD17118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1639195407",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "027063100",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.