David M Jackson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

9104510 Issued in FL

Practice address

1133 Saxon Blvd
Prompt Care
Orange City, FL 32763-0000

Phone

(904) 305-3221

NPI assigned

Jun 28, 2006

Last updated

Aug 1, 2012By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northeast Florida Health Services, Inc.

  dba Family Health Source

  • Federally Qualified Health Center (FQHC)
  • Pierson, FL
  • NPI 1992792311
  Medicare reassignment
• Bon Secours Urgent Care LLC

  • Urgent Care Clinic/Center
  • Glen Allen, VA
  • NPI 1265160501
  Medicare reassignment
• Roanoke Valley Healthcare Partners, LLC

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1619274446
  Medicare reassignment
• Northeast Florida Health Services Inc

  dba Family Health Source

  • Federally Qualified Health Center (FQHC)
  • Deltona, FL
  • NPI 1427605534
  NPD
• Northeast Florida Health Services, Inc.

  dba Family Health Source

  • Federally Qualified Health Center (FQHC)
  • South Daytona, FL
  • NPI 1396282208
  NPD
• Doctors Inlet Pediatrics and Primary Care

  dba Doctors Inlet Internal Medicine, Spine and Pain

  • Internal Medicine Physician
  • Middleburg, FL
  • NPI 1518328301
  NPD (past)
• Blue Ridge Healthcare Partners, LLC

  • Primary Care Clinic/Center
  • Roanoke, VA
  • NPI 1518304955
  NPD (past)
• Short Pump Family Care, LLC

  • Primary Care Clinic/Center
  • Midlothian, VA
  • NPI 1487068334
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343779200000",
    "number": "1952338485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2223 ASTOR ST",
            "address_2": "PA2",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735668",
            "telephone_number": "904-305-3221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 SAXON BLVD",
            "address_2": "PROMPT CARE",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327630000",
            "telephone_number": "904-305-3221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DAVID",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2012-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "01108408409",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9104510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Intergrated Alternative Professionals
• Interventional Pain Rehab and Regenerative Center of Florida (Anti-Aging, Regeneration and Pain Center)
• Kathleen Iosue, ARNP
• Miranda Itule
• Brianna Jackson, CPM, LM
• Sheryl L. Jackson, MS, CCC-A
• Kwana Jacobs
• Maya Jacobs
• Jaime J Perez DC Inc (OneCare Health Associates)
• Fiaz Ahmad Jaleel, M.D

• Medical Physician Assistant in Orange City, FL
• Providers in Orange City, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; 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.