Active NPI
Peta-Gay Jackson-Booth, M.D.
- Internal Medicine Physician
- Baltimore, MD
National Provider Identifier
1760426902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- D0052122
- Practice address
- 2200 Kernan Drive
Baltimore, MD 21207 - Phone
- (410) 448-6283
- Fax
- (410) 448-6277
- NPI assigned
- Jun 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | D0052122 | MD | Primary |
Addresses
Primary practice location
2200 Kernan Drive
Baltimore, MD 21207
Mailing address
2200 Kernan Drive
Baltimore, MD 21207
Phone (410) 448-6283
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110229896 | Medicaid | MD |
Other names 1
- Peta-Gay Jackson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0052122 | MD | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mochi Medical Ca PC | Past | Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
-
- Obesity Medicine (Family Medicine) Physician
- San Francisco, CA
- NPI 1174303374
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251849600000",
"number": "1760426902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 KERNAN DRIVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "21207",
"telephone_number": "410-448-6283",
"fax_number": "410-448-6277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 KERNAN DRIVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "21207",
"telephone_number": "410-448-6283",
"fax_number": "410-448-6277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON-BOOTH",
"first_name": "PETA-GAY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-16",
"last_updated": "2009-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MD",
"license": "D0052122",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110229896",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PETA-GAY",
"last_name": "JACKSON",
"credential": "MD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.