Susan Marie Jackson, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS015552 Issued in PA

Practice address

25066 Sr 11
Hallstead, PA 18822

Phone

(570) 879-5249

Fax

(570) 879-2418

NPI assigned

Dec 22, 2006

Last updated

May 8, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Kansas City University of Physicians and Surgeons, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Our Lady of Lourdes Memorial Hospital IncGroup PAC ID 1254237779, 249 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Twin Tier Home Health, Inc Home health agency, Johnson City, NY, CCN 337181
• Our Lady of Lourdes Memorial Hospital, Inc Hospital, Binghamton, NY, CCN 330011
• United Health Services Hospitals, Inc Hospital, Binghamton, NY, CCN 330394

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sjackson196825@direct-guthrie.org
• Direct secure messaging: susan.jackson.1@31395.direct.athenahealth.com

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.

• Our Lady of Lourdes Memorial Hospital Inc.

  dba Lourdes

  • General Acute Care Hospital
  • Binghamton, NY
  • NPI 1629087580
  Medicare reassignment Care Compare group NPD
• Our Lady of Lourdes Memorial Hospital, Inc.

  dba Lourdes

  • Family Medicine Physician
  • Binghamton, NY
  • NPI 1063557189
  NPD
• Our Lady of Lourdes Memorial Hospital, Inc.

  • Specialty Pharmacy
  • Johnson City, NY
  • NPI 1730982596
  NPD

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

• Our Lady of Lourdes Memorial Hospital Inc.

  dba Lourdes

  • General Acute Care Hospital
  • Binghamton, NY
  • NPI 1629087580
  Care Compare affiliation
• Twin Tier Home Health, Inc.

  • Home Health Agency
  • Johnson City, NY
  • NPI 1760489405
  Care Compare affiliation
• United Health Services Hospitals, Inc.

  • General Acute Care Hospital
  • Binghamton, NY
  • NPI 1518998699
  Care Compare affiliation

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367971200000",
    "number": "1780749671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25054 SR 11",
            "city": "HALLSTEAD",
            "state": "PA",
            "postal_code": "18822",
            "telephone_number": "570-879-6870",
            "fax_number": "570-879-6861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25066 SR 11",
            "city": "HALLSTEAD",
            "state": "PA",
            "postal_code": "18822",
            "telephone_number": "570-879-5249",
            "fax_number": "570-879-2418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-22",
        "last_updated": "2013-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2000163890",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "244722",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS015552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02903533",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Joseph Gnad, MS OTR/L
• Jeffrey Gonz, OPTICIAN
• Hallstead Family Pharmacy LLC
• Kirk S Hinkley IV, MD
• Donna C Holinej, RPH
• Neal Juraska, PHARMD
• Kristin Marie Longacre, R.N.
• Joseph Patrick McKeon, OTRL
• Todd Mitchell, DPM
• Andrea Moon, OTR/L

• Family Medicine Physician in Hallstead, PA
• Providers in Hallstead, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; 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.