Avery Michael Jackson III, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

AJ076974 Issued in MI

Practice address

9400 S Saginaw Rd Ste a
Grand Blanc, MI 48439-9666

Phone

(810) 606-7200

Fax

(810) 606-7115

NPI assigned

Jun 28, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

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.

Opted out of Medicare

Yes, effective Oct 1, 2026 through Oct 1, 2028

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: avery.jackson.1@30652.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 and National Provider Directory roles.

• Michigan Neurosurgical Institute, P.C

  • Neurological Surgery Physician
  • Grand Blanc, MI
  • NPI 1336184571
  Medicare reassignment NPD Authorized official
• Advanced Pain Management of Caro PC

  • Pain Medicine Physician
  • Caro, MI
  • NPI 1780454587
  Medicare reassignment NPD
• Michigan Neurosurgical Institute PC

  • Durable Medical Equipment & Medical Supplies
  • Grand Blanc, MI
  • NPI 1598930968
  NPD
• Genesys Regional Medical Center

  • Diagnostic Radiology Physician
  • Lapeer, MI
  • NPI 1134152226
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1851329197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4620 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398067",
            "telephone_number": "810-606-7200",
            "fax_number": "810-606-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 S SAGINAW RD STE A",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484399666",
            "telephone_number": "810-606-7200",
            "fax_number": "810-606-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AVERY",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MI",
            "license": "AJ076974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPLUS OF MICHIGAN",
            "identifier": "0993708",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4568263",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Florina Ivan, RPH
• Tamara Roumayah Ivers, MD
• J Martin Ulrich DO PC
• Matthew Jaboro
• Jackson Chiropractic Clinic, PC
• Caramarie Jackson, PA-C
• Charles Arthur Jackson Jr., D.C.
• Evelyn Jackson, CRNA
• Givaunni S Jackson
• Erica Jacob, CCC-SLP

• Neurological Surgery Physician in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• Neurological Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.