Phillip Anthony Jackson Jr., CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R230527 Issued in MD

Practice address

22 S Greene St
Baltimore, MD 21201-1544

Phone

(410) 328-8667

NPI assigned

Jun 13, 2022

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

Medicare fee-for-service enrollment

Enrolled in MD

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 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Maryland Midtown Health IncGroup PAC ID 1557640356, 12 clinicians

University of Maryland Emergency Medicine Associates PAGroup PAC ID 1951294941, 57 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pjackson450076@direct.umm.edu

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.

• University of Maryland Emergency Medicine Associates, PA

  • Emergency Medicine Physician
  • Baltimore, MD
  • NPI 1144271743
  Medicare reassignment Care Compare group NPD
• University of Maryland Midtown Health Inc

  • Urgent Care Clinic/Center
  • Baltimore, MD
  • NPI 1710347729
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1655078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1992435036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "410-328-8667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "410-328-8667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PHILLIP",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-13",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "R230527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Myrna C. Jackson
• Niya Danielle Jackson
• Olander B. Jackson
• Onestie Sabine Jackson, BCBA
• Pattie D. Jackson, LCSW-C
• Prudence Jackson, MD
• Rachel Allison Jackson
• Rebecca Ann Jackson
• Rebecca Yvette Jackson, NP
• Rosa Jackson, LGSW

• Nurse Practitioner in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; 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.