DR. TEDROY MEVRICK JACKSON MD
NPI 1356091490
Internal Medicine in Cincinnati, OH

Q: What is Tedroy Jackson's NPI number?

The NPI number for Tedroy Jackson is 1356091490. It was assigned to this individual provider in the NPPES registry on March 23, 2022.

Q: What is Tedroy Jackson's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Tedroy Jackson was last updated on June 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 23, 2022PECOS EnrolledAccepts Medicare Assignment

2123 AUBURN AVE STE 235, CINCINNATI, OH 45219(513) 585-3238 Get Directions Write a Review

NPPES record last updated: June 10, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Dr. Tedroy Mevrick Jackson Md NPPES

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

DR. TEDROY MEVRICK JACKSON MD (NPI 1356091490) is an individual internal medicine provider in Cincinnati, Ohio, licensed in Washington (MD61645378) and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS, is affiliated with Skagit Valley Hospital, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1356091490

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameDR. TEDROY MEVRICK JACKSONCredential: MD

Location Address2123 AUBURN AVE STE 235Cincinnati, OH 45219-2906

Mailing Address2123 Auburn Ave Ste 340Cincinnati, OH 45219-2906

Phone(513) 585-3238

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateMarch 23, 2022

Last NPPES UpdateJune 10, 2026

NPPES CertifiedJune 10, 2026

✔ NPI 1356091490 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 WA · MD61645378

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 ListedHospitalistTaxonomy 208M00000X · License MD.MD.61645378 (WA)

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

2123 AUBURN AVE STE 235, Cincinnati, OH 45219

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Tedroy Mevrick Jackson Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2668851601

PECOS Enrollment IDI20250728003207

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Skagit Valley Hospital

Acute Care Hospitals · Mount Vernon, WA

3/5 CMS rating

OwnershipGovernment - Hospital District or Authority

CMS Certification Number500003

Location1415 E Kincaid StreetMount Vernon, WA 98274 · Skagit County

Emergency services Birthing friendly

Cascade Valley Hospital

Acute Care Hospitals · Arlington, WA

1/5 CMS rating

OwnershipGovernment - Hospital District or Authority

CMS Certification Number500060

Location330 S Stillaguamish AveArlington, WA 98223 · Snohomish County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45219 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$126.12 typical visit price

range $54.34 – $166.65

Typical copayment $31.53 (range $13.58 – $41.66)

Most-billed visit code 99204

Established Patient

$96.44 typical visit price

range $17.10 – $135.40

Typical copayment $24.11 (range $4.27 – $33.85)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

TIFFANY EILIN LOH

Student in an Organized Health Care Education/Training Program