Active NPI
Lori K Jackson, P.A.
- Physician Assistant
- Lewiston, ME
National Provider Identifier
1912965880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA852
- Practice address
- 300 Main St
Lewiston, ME 04240-7027 - Phone
- (207) 795-0111
- Fax
- (207) 795-2766
- NPI assigned
- May 2, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA852 | ME | Primary |
Addresses
Primary practice location
300 Main St
Lewiston, ME 04240-7027
Mailing address
300 Main St
Lewiston, ME 04240-7027
Phone (207) 795-0111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912965880 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023467 | NY | MD | Occupational Therapist |
| PA852 | ME | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Medical PC | Current | Accepting new patients | |
| Sunbury Primary Care, P.a. | Physician Assistant | Past | Accepting new patients |
Locations
5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592
Interoperability endpoints
- ljackson2752736@direct.trinity-health.org
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Liverpool, NY
- NPI 1972563070
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464912000000",
"number": "1912965880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 MAIN ST",
"city": "LEWISTON",
"state": "ME",
"postal_code": "042407027",
"telephone_number": "207-795-0111",
"fax_number": "207-795-2766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 MAIN ST",
"city": "LEWISTON",
"state": "ME",
"postal_code": "042407027",
"telephone_number": "207-795-0111",
"fax_number": "207-795-2766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LORI",
"middle_name": "K",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-02",
"last_updated": "2016-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ME",
"license": "PA852",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1912965880",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lewiston, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.