Jackson P Ward IV, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

03220 Issued in GA

Practice address

750 Townpark LN NW
Town Park Comprehensive Medical Center
Kennesaw, GA 30144-5579

Phone

(770) 514-5401

Fax

(770) 994-4747

NPI assigned

Nov 22, 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Maxfield Medical LLCGroup PAC ID 7618333121, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.62 of 100Reported as apm

Quality

83.25

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Maxfield Medical LLC

  • Urgent Care Clinic/Center
  • Cumming, GA
  • NPI 1619673035
  Medicare reassignment Care Compare group
• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956
  Medicare reassignment Care Compare group
• Physicians Express Care LLC

  • Urgent Care Clinic/Center
  • Alpharetta, GA
  • NPI 1528336674
  Medicare reassignment NPD (past)
• Emerginet SRMC, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Atlanta, GA
  • NPI 1538118344
  Medicare reassignment
• Emerginet, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Atlanta, GA
  • NPI 1164480869
  Medicare reassignment
• Piedmont Hospitalist Physicians LLC

  • Family Medicine Physician
  • Stockbridge, GA
  • NPI 1548219660
  Medicare reassignment
• Physician'S Express Care at Creekstone

  • Urgent Care Clinic/Center
  • Cumming, GA
  • NPI 1578955795
  NPD
• Cherokee Emergency Services, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Atlanta, GA
  • NPI 1992754717
  NPD (past)
• Northside Cherokee Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Atlanta, GA
  • NPI 1740515618
  NPD (past)
• Parkway Anesthesia Consultants, PC

  • Certified Registered Nurse Anesthetist
  • Villa Rica, GA
  • NPI 1194887455
  NPD (past)

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641513600000",
    "number": "1891860144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT RD NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051717",
            "telephone_number": "404-504-5678",
            "fax_number": "770-994-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 TOWNPARK LN NW",
            "address_2": "TOWN PARK COMPREHENSIVE MEDICAL CENTER",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301445579",
            "telephone_number": "770-514-5401",
            "fax_number": "770-994-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARD",
        "first_name": "JACKSON",
        "middle_name": "P",
        "name_suffix": "IV",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2022-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "03220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "750 Townpark Ln NW",
            "city": "Kennesaw",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301445579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carol S Wallace, PHARM. D.
• Lydia Walters, M.S., ED.S. LPC
• Patrice M Walton, NP-C
• William Wha Wang, O.D.
• Diana M Ward, RN
• Stacey Warren, LPN
• Kwanza Washington, FNP-C
• Renete Washington, LPC, LMHC
• Tylyn Washington, RBT
• Sharon Y Waters, M.D.

• Medical Physician Assistant in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2022; 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.