Individual provider Active NPI

Erin Audrey Marie Jackson, M.D

  • Pediatrics Physician
  • Pensacola, FL
National Provider Identifier
1912326513
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME168082 Issued in FL
Practice address
5153 N 9TH Ave Ste 5F
Pensacola, FL 32504-8785
Phone
(850) 416-1890
Fax
(850) 416-1891
NPI assigned
Apr 10, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME168082 FL Primary

Addresses

Primary practice location

5153 N 9TH Ave Ste 5F
Pensacola, FL 32504-8785

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623
Phone (904) 450-6063

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, FL2 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

Enrollment IDStateProvider typePAC IDDetails
I20171003004179 MS Practitioner - Pediatric Medicine 1557636420 Reassigns benefits to 1 organization
I20240613003346 FL Practitioner - Hematology/Oncology 1557636420

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-6441

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
67.75
Promoting interoperability
100
Improvement activities
40
Cost
71.17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Aug 23, 2017 Accepting new patients
Sacred Heart Health System, Inc. Current Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Aug 23, 2017 Accepting new patients
Sacred Heart Health System, Inc. PastSince Oct 6, 2024 Accepting new patients

Locations

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

350 Heritage Way
Ste 1100
Kalispell, MT 59901
Phone (406) 752-8900

Interoperability endpoints

  • Direct secure messaging: ejackson77982@ummc.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1912326513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-450-6063",
            "fax_number": "904-539-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5153 N 9TH AVE STE 5F",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048785",
            "telephone_number": "850-416-1890",
            "fax_number": "850-416-1891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ERIN",
        "middle_name": "AUDREY MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-10",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME168082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.