Todd Jackson Jr., MD, MPH

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

90618 Issued in GA

Practice address

5665 New Northside Dr Ste 200
Atlanta, GA 30328-4617

Phone

(404) 778-5975

Fax

(404) 778-2630

NPI assigned

Apr 7, 2020

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 GA, NC2 enrollments

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 2

Specialty

Emergency Medicine

Education

University of Miami, LM Miller School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sandy Creek Emergency Group, PCGroup PAC ID 3577905520, 44 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Fayette Hospital Hospital, Fayetteville, GA, CCN 110215

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

98.67

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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.

• Sandy Creek Emergency Group, PC

  • Emergency Medicine Physician
  • Fayetteville, GA
  • NPI 1427817881
  Medicare reassignment Care Compare group NPD
• Emergency Group of Columbus, LLC

  • Emergency Medicine Physician
  • Columbus, GA
  • NPI 1316458227
  Medicare reassignment NPD
• Heritage Physician Services, LLC

  • Emergency Medicine Physician
  • Columbus, GA
  • NPI 1003321969
  Medicare reassignment NPD
• Houston County Emergency Group, LLC

  • Emergency Medicine Physician
  • Warner Robins, GA
  • NPI 1013338193
  Medicare reassignment NPD
• Lagrange Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Lagrange, GA
  • NPI 1760437560
  Medicare reassignment NPD
• Tarheel Emergency Group, PLLC

  • Emergency Medicine Physician
  • Jacksonville, NC
  • NPI 1386388874
  Medicare reassignment NPD
• The Carolinas Emergency Group, PLLC

  • Emergency Medicine Physician
  • Dunn, NC
  • NPI 1477508836
  Medicare reassignment NPD
• Houston County Emergency Group, LLC

  • Emergency Medicine Physician
  • Perry, GA
  • NPI 1467873547
  NPD

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

• Fayette Community Hospital, Inc.

  • General Acute Care Hospital
  • Fayetteville, GA
  • NPI 1528027240
  Care Compare affiliation

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1821627225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 HILLTOP DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303156019",
            "telephone_number": "404-983-5256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5665 NEW NORTHSIDE DR STE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303284617",
            "telephone_number": "404-778-5975",
            "fax_number": "404-778-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TODD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-07",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "90618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya Tamara Jackson, APRN
• Tara Jackson, M.ED.
• Taylor Jackson, DC
• Taylor Simone Jackson
• Tiphani Jackson, PT, DPT, ATC
• Troya Lusand Jackson, LMSW
• Twyla Douglas Jackson I, RDN, CSO, LD
• Tyler-Leah C Jackson, LCSW
• Vanessa Jane Jackson, MSW
• Vanna Manigault Jackson, MD FAAP

• Emergency Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Emergency Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; 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.