Individual provider Active NPI

Daniel Solomon Jackson, PA-S

  • Physician Assistant
  • Chesapeake, VA
National Provider Identifier
1780494666
Registry record updated Jan 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110011156 Issued in VA
Practice address
817 Volvo Pkwy
Chesapeake, VA 23320-2855
Phone
(757) 668-4630
Fax
(757) 668-4635
NPI assigned
Jan 13, 2025
Last updated
Jan 30, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110011156 VA Primary

Addresses

Primary practice location

817 Volvo Pkwy
Chesapeake, VA 23320-2855

Mailing address

601 Childrens LN
Norfolk, VA 23507-1910
Phone (757) 668-4630

Other practice location 1

3960 Virginia Beach Blvd Ste 101
Virginia Beach, VA 23452-2449
Phone (757) 668-4846

Other practice location 2

680 Oyster Point Rd Ste 105
Newport News, VA 23606-4570
Phone (757) 668-4851

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20260414003088 VA Practitioner - Physician Assistant 8921574385 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

601 Childre's LN
Norfolk, VA 23507-1910

601 Childrens LN
Norfolk, VA 23507-1971

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110011156VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Hospital of the Kings Daughters 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769731200000",
    "number": "1780494666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 CHILDRENS LN",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071910",
            "telephone_number": "757-668-4630",
            "fax_number": "757-668-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 VOLVO PKWY",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233202855",
            "telephone_number": "757-668-4630",
            "fax_number": "757-668-4635"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3960 Virginia Beach Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234522449",
            "country_code": "US",
            "telephone_number": "757-668-4846",
            "fax_number": "757-668-4646",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "680 Oyster Point Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Newport News",
            "state": "VA",
            "postal_code": "236064570",
            "country_code": "US",
            "telephone_number": "757-668-4851",
            "fax_number": "757-668-4897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DANIEL",
        "middle_name": "SOLOMON",
        "credential": "PA-S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-13",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110011156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

Verify at the official NPI Registry.