Theodore A. Jackson, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

13531 Issued in WV

Practice address

1306 Kanawha Blvd E
Suite 100
Charleston, WV 25301-3001

Phone

(304) 342-1113

Fax

(304) 346-2271

NPI assigned

Aug 31, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Hans Lee MD Inc

  • Plastic Surgery Physician
  • Charleston, WV
  • NPI 1003800442
  Medicare reassignment NPD Authorized official
• Camc Greenbrier Valley Medical Center Inc

  • Cardiovascular Disease Physician
  • Ronceverte, WV
  • NPI 1588373872
  Medicare reassignment NPD
• Camc Greenbrier Valley Medical Center, Inc.

  • Rural Health Clinic/Center
  • Peterstown, WV
  • NPI 1588485478
  NPD

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236816000000",
    "number": "1942294376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 KANAWHA BLVD E",
            "address_2": "SUITE 100",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253013001",
            "telephone_number": "304-342-1113",
            "fax_number": "304-346-2271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 KANAWHA BLVD E",
            "address_2": "SUITE 100",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253013001",
            "telephone_number": "304-342-1113",
            "fax_number": "304-346-2271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "THEODORE",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2009-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "WV",
            "license": "13531",
            "primary": true
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "WV",
            "license": "13531",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0051155000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Jackson
• Sade A Jackson
• Shiffon Jackson
• Tenika Jackson
• Teresa Jackson
• Sally Jacob
• Andres Jose Jadue Tobar, MD
• Anthony R. Jafari, APRN-CNP
• Baqir H Jafry, MD
• Thopsie V Jagannath, MD

• Plastic Surgery Physician in Charleston, WV
• Providers in Charleston, WV by specialty
• Plastic Surgery Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2009; 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.

Verify at the official NPI Registry.