Active NPI
Lisa Wilhelm Jackson, MS, RD, LDN, CNSC
- Registered Dietitian
- Baltimore, MD
National Provider Identifier
1992950737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DX3435
- Practice address
- 1800 Orleans St
Bloomberg 9306
Baltimore, MD 21287-0010 - Phone
- (410) 614-4486
- NPI assigned
- Nov 20, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164004668 | IL | |
| Registered Dietitian | 133V00000X | DX3435 | MD | Primary |
Addresses
Primary practice location
1800 Orleans St
Bloomberg 9306
Baltimore, MD 21287-0010
Mailing address
1800 Orleans St
Bloomberg 9306
Baltimore, MD 21287-0010
Phone (410) 614-4486
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164004668 | IL | MD | Registered Dietitian |
| DX3435 | MD | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Johns Hopkins Hospital | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Children's Chronic Disease Hospital
- Baltimore, MD
- NPI 1104234590
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410739200000",
"number": "1992950737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 ORLEANS ST",
"address_2": "BLOOMBERG 9306",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212870010",
"telephone_number": "410-614-4486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 ORLEANS ST",
"address_2": "BLOOMBERG 9306",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212870010",
"telephone_number": "410-614-4486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LISA",
"middle_name": "WILHELM",
"credential": "MS, RD, LDN, CNSC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-20",
"last_updated": "2014-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164004668",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MD",
"license": "DX3435",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.