Ophelia Faye Jackson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

047262-1 Issued in NY

Practice address

429 W 24TH St
New York, NY 10011-1225

Phone

(516) 459-4739

Fax

(212) 206-0298

NPI assigned

Sep 15, 2006

Last updated

Jan 13, 2015By 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 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ophjackson@montefioredirect.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.

• William F Ryan Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • New York, NY
  • NPI 1851328199
  Medicare reassignment NPD
• William F Ryan Community Health Center Inc

  dba Ryan Health Midtown Emotional Wellness Center

  • Federally Qualified Health Center (FQHC)
  • New York, NY
  • NPI 1043079064
  NPD
• William F Ryan Community Health Center Inc

  dba Thelma C Davidson Adair William F. Ryan Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • New York, NY
  • NPI 1730317769
  NPD

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421107200000",
    "number": "1841396108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "429 W 24TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100111225",
            "telephone_number": "516-459-4739",
            "fax_number": "212-206-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 W 24TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100111225",
            "telephone_number": "516-459-4739",
            "fax_number": "212-206-0298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "OPHELIA",
        "middle_name": "FAYE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2015-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "047262-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naomi Jackson
• Natia Jackson
• Norma J Jackson, M.D.
• Olivia Jackson
• Olivia Jackson, RN
• Peter Jackson
• Poppy Christina Jackson, DNP, AGPCNP-BC
• Quiana M Jackson
• Ralph K. Jackson, M.D.
• Reesha Jackson

• Dentist in New York, NY
• Providers in New York, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.