Lillie Jackson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.1146 Issued in AL

Practice address

4704 Cahaba River Rd # 101D
Birmingham, AL 35243-2344

Phone

(205) 739-2266

Fax

(205) 739-2335

NPI assigned

Jul 15, 2016

Sex

Female

Sole proprietor

Yes

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 AL

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

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Metro Infectious Disease Consultants LLCGroup PAC ID 3072425784, 386 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grandview Medical Center Hospital, Birmingham, AL, CCN 010104

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Metro Infectious Disease Consultants, LLC

  • Infectious Disease Physician
  • Burr Ridge, IL
  • NPI 1235125717

  AL

  Medicare reassignment Care Compare group NPD
• Oak Mountain Group Services, LLC

  • Hospitalist Physician
  • Birmingham, AL
  • NPI 1366840761
  Medicare reassignment NPD
• Rosemore Primary Care & Rehab Services LLC

  • Family Medicine Physician
  • Birmingham, AL
  • NPI 1639561244
  Medicare reassignment
• Metro Infectious Disease Consultants LLC

  • Infectious Disease Physician
  • Jonesboro, GA
  • NPI 1770307191
  NPD
• Metro Infectious Disease Consultants, LLC

  • Infectious Disease Physician
  • Plymouth, MI
  • NPI 1841530250
  NPD (past)

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

• Affinity Hospital LLC

  • General Acute Care Hospital
  • Birmingham, AL
  • NPI 1023061405
  Care Compare affiliation

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

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546214400000",
    "number": "1881047710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2391",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352012391",
            "telephone_number": "205-868-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4704 CAHABA RIVER RD # 101D",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352432344",
            "telephone_number": "205-739-2266",
            "fax_number": "205-739-2335"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3800 Ridgeway Dr",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352095506",
            "country_code": "US",
            "telephone_number": "205-868-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LILLIE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-15",
        "last_updated": "2018-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA.1146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kennedy Jackson
• Kim Jackson
• Kimberly Rae Ward Jackson, MD
• Kimberly S Jackson, RN
• Larry K Jackson, M.D.
• Margaret Jackson
• Mary Brittany Revell Jackson, OTR/L
• Rasheen Jackson, PHARM.D.
• Rebecca Leigh Jackson, PT
• Rekita Jackson, LPC

• Physician Assistant in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2018; 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.