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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

DR. CODY BOYER JACKSON MD, PHD
NPI 1255033304
Internal Medicine in Philadelphia, PA

Active since March 21, 2023
3400 CIVIC CENTER BLVD FL 1, PHILADELPHIA, PA 19104(215) 615-5864 Get Directions Write a Review

NPPES record last updated: July 8, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 8, 2026, Jun 6, 2026, Apr 11, 2025 and 2 more (5 updates tracked since 2023).

About Dr. Cody Boyer Jackson Md, Phd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. CODY BOYER JACKSON MD, PHD (NPI 1255033304) is an individual internal medicine provider in Philadelphia, Pennsylvania, licensed in Oregon (MD223559) and active in the NPI registry since March 2023.

NPPES Registry Identity

NPI1255033304
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. CODY BOYER JACKSONCredential: MD, PHD
Location Address3400 CIVIC CENTER BLVD FL 1Philadelphia, PA 19104-5161
Mailing Address3400 Spruce St, West Gates Building 839Philadelphia, PA 19104-4238 · (215) 615-5864
Phone(215) 615-5864
Sole ProprietorNo
Enumeration DateMarch 21, 2023
Last NPPES UpdateJuly 8, 20265 updates tracked since enumeration
NPPES CertifiedJuly 8, 2026
✔ NPI 1255033304 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in OR · MD223559
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedInternal Medicine · Critical Care MedicineTaxonomy 207RC0200X · License MT237978 (PA)
Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X · License MT237978 (PA)
3400 CIVIC CENTER BLVD FL 1, Philadelphia, PA 19104
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DAVID MICHAEL DIBARDINO M.D.
Internal Medicine (Critical Care Medicine)
3400 CIVIC CENTER BLVD FL 1
PHILADELPHIA, PA 19104
Philadelphia County (215) 662-3202
HAROLD I PALEVSKY MD
Internal Medicine (Critical Care Medicine)
3400 CIVIC CENTER BLVD FL 1
PHILADELPHIA, PA 19104
Philadelphia County (215) 662-3202
NAHREEN H AHMED
Internal Medicine (Pulmonary Disease)
3400 CIVIC CENTER BLVD FL 1
PHILADELPHIA, PA 19104
Philadelphia County (215) 662-3202
CHEILONDA R JOHNSON M.D.
Internal Medicine (Pulmonary Disease)
3400 CIVIC CENTER BLVD FL 1
PHILADELPHIA, PA 19104
Philadelphia County (215) 662-3202
STEVEN CASEY PUGLIESE M.D.
Internal Medicine (Critical Care Medicine)
3400 CIVIC CENTER BLVD FL 1
PHILADELPHIA, PA 19104
Philadelphia County (215) 662-3202
JOSHUA BERKMAN KAYSER MD
Internal Medicine (Critical Care Medicine)
3400 CIVIC CENTER BLVD FL 1
PHILADELPHIA, PA 19104
Philadelphia County (215) 662-3202
MICHAEL G SHASHATY MD
Internal Medicine (Critical Care Medicine)
3400 CIVIC CENTER BLVD FL 1
PHILADELPHIA, PA 19104
Philadelphia County (215) 662-3202
JOANNA HART M.D.
Internal Medicine (Critical Care Medicine)
3400 CIVIC CENTER BLVD FL 1
PHILADELPHIA, PA 19104
Philadelphia County (215) 662-3202

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Cody Jackson's NPI number?

The NPI number for Cody Jackson is 1255033304. It was assigned to this individual provider in the NPPES registry on March 21, 2023.

Where is Cody Jackson located?

Cody Jackson practices at 3400 Civic Center Blvd Fl 1, Philadelphia, PA 19104. The listed phone number is (215) 615-5864.

What is Cody Jackson's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

When was this NPI record last updated?

The NPPES record for Cody Jackson was last updated on July 8, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.