Ulysses D Jackson III

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

205 Wadsworth Rd
Wadsworth, OH 44281-9580

Phone

(234) 217-8882

NPI assigned

Mar 4, 2020

Last updated

Nov 27, 2023By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: jacksonulysses@communityassessment.org

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.

• Community Assessment and Treatment Services, Inc

  • Substance Abuse Rehabilitation Facility
  • Cleveland, OH
  • NPI 1497871719
  NPD (past)
• Community Assessment and Treatment Services, Inc

  • Community/Behavioral Health Agency
  • Cleveland, OH
  • NPI 1932580545
  NPD (past)

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

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1942835467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 WADSWORTH RD",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442819580",
            "telephone_number": "330-564-5445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 WADSWORTH RD",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442819580",
            "telephone_number": "234-217-8882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ULYSSES",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-04",
        "last_updated": "2023-11-27",
        "certification_date": "2020-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jacksonulysses@communityassessment.org",
            "affiliation": "Y",
            "endpointDescription": "Email",
            "affiliationName": "Community Assessment And Treatment Services, Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "205 Wadsworth Rd",
            "city": "Wadsworth",
            "state": "OH",
            "country_code": "US",
            "postal_code": "442819580",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Illumination Counseling and Consulting Services LLC
• Imaging Centers of Ohio, LLC (Wadsworth Diagnostic Imaging Centers)
• Inmotion Physical Therapy and Wellness LLC
• Bethany Marie Jackson
• Donovan Jackson
• Tamara E Jaklitsch
• Angel Dawn James
• Lindsay R. James, LAT
• Heather Jamison, LISW-S
• Vanessa M Jarrett, LPN

• Addiction (Substance Use Disorder) Counselor in Wadsworth, OH
• Providers in Wadsworth, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.