Mitchell Alin Jackson, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

036083377 Issued in IL

Practice address

300 N Milwaukee Ave
Suite L Jacksoneye SC
Lake Villa, IL 60046

Phone

(847) 356-0700

Fax

(847) 356-0757

NPI assigned

Jan 18, 2007

Last updated

Jan 9, 2014By the provider in NPPES

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 3

Medicare fee-for-service enrollment

Enrolled in IL, WI2 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

Ophthalmology

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jacksoneye SCGroup PAC ID 3072405737, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

79.11 of 100Reported as group

Quality

100

Improvement activities

40

Cost

30.37

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mjackson@jacksoneye.emadirect.md

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.

• Jacksoneye SC

  • Ophthalmology Physician
  • Lake Villa, IL
  • NPI 1073669834

  WI

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389225600000",
    "number": "1902958929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N MILWAUKEE AVE",
            "address_2": "SUITE L JACKSONEYE SC",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "60046",
            "telephone_number": "847-356-0700",
            "fax_number": "847-356-0757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N MILWAUKEE AVE",
            "address_2": "SUITE L JACKSONEYE SC",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "60046",
            "telephone_number": "847-356-0700",
            "fax_number": "847-356-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MITCHELL",
        "middle_name": "ALIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2014-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036083377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS #",
            "identifier": "0004932263",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083377",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "208201",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcelle Ann Hepburn, LAC
• Danielle Herrndobler, LPC
• Ramona C Hickey
• Laura Houston, SLP
• Kathleen L Hufnagle, D.C.
• Jacksoneye SC
• Deana Lynn Jaros, DT
• Danielle Jin, PHARMD
• Elaine Johnson
• Victor Jorden, M.D., M.P.H.

• Ophthalmology Physician in Lake Villa, IL
• Providers in Lake Villa, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2014; 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.