Timothy L Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110002037 Issued in VA

Practice address

5249 Providence Rd
Virginia Beach, VA 23464-4201

Phone

(757) 467-3900

Fax

(757) 467-7800

NPI assigned

Jul 19, 2006

Last updated

Jun 3, 2026By 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

Electronic endpoints 6

Medicare fee-for-service enrollment

Enrolled in VA, NC2 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

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

97.45 of 100Reported as group

Promoting interoperability

97

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: timothy.jackson@forefrontdermatology.emadirect.md

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.

• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Goldsboro, NC
  • NPI 1326532169
  Medicare reassignment Care Compare group NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Vienna, VA
  • NPI 1891169975
  Medicare reassignment
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Virginia Beach, VA
  • NPI 1003787748
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Columbus, OH
  • NPI 1063365385
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Manitowoc, WI
  • NPI 1578515904
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780444800000",
    "number": "1982623625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5249 PROVIDENCE RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234644201",
            "telephone_number": "757-467-3900",
            "fax_number": "757-467-7800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3825 CONLON WAY #100",
            "address_purpose": "LOCATION",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "27909",
            "country_code": "US",
            "telephone_number": "252-331-5869",
            "fax_number": "252-331-5906",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5589 N Croatan Hwy",
            "address_purpose": "LOCATION",
            "city": "Kitty Hawk",
            "state": "NC",
            "postal_code": "279493996",
            "country_code": "US",
            "telephone_number": "252-715-0610",
            "fax_number": "252-715-0612",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2206 Executive Dr Ste F",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "VA",
            "postal_code": "236662583",
            "country_code": "US",
            "telephone_number": "757-825-1440",
            "fax_number": "757-825-1587",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1157 First Colonial Rd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234542432",
            "country_code": "US",
            "telephone_number": "757-333-8001",
            "fax_number": "757-333-8002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "525 S INDEPENDENCE BLVD STE 215",
            "address_purpose": "LOCATION",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234521188",
            "country_code": "US",
            "telephone_number": "757-467-3900",
            "fax_number": "757-467-7800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIMOTHY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-00505",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110002037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Timothy.Jackson@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "2206 Executive Dr Ste F",
            "city": "Hampton",
            "state": "VA",
            "country_code": "US",
            "postal_code": "236662583",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Timothy.Jackson@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "525 S INDEPENDENCE BLVD STE 215",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "country_code": "US",
            "postal_code": "234521188",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Timothy.Jackson@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "3825 CONLON WAY #100",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "country_code": "US",
            "postal_code": "27909",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Timothy.Jackson@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "5249 Providence Rd",
            "city": "Virginia Beach",
            "state": "VA",
            "country_code": "US",
            "postal_code": "234644201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Timothy.Jackson@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "1157 First Colonial Rd Ste 300",
            "city": "Virginia Beach",
            "state": "VA",
            "country_code": "US",
            "postal_code": "234542432",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Timothy.Jackson@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "5589 N Croatan Hwy",
            "city": "Kitty Hawk",
            "state": "NC",
            "country_code": "US",
            "postal_code": "279493996",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shaylie Jackson
• Shelby Jackson
• Stephanie Jackson, MSW
• Tazhane Jackson
• Tianna Lashae Jackson
• Tomicka Jackson
• Tyhesha Jackson
• Jacob L. Saxton, DDS, PC (Aesthetic Family Dentistry)
• Tammy Jacob-Perez, NP
• Jasmine A Jacob, OTD, OTR/L

• Physician Assistant in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.