DR. JORDAN MARIE JACKSON MD
NPI 1417680513
Student in an Organized Health Care Education/Training Program in Detroit, MI

Q: What is Jordan Jackson's NPI number?

The NPI number for Jordan Jackson is 1417680513. It was assigned to this individual provider in the NPPES registry on July 6, 2022.

Q: What is Jordan Jackson's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Jordan Jackson was last updated on April 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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 July 06, 2022PECOS Enrolled

2799 W GRAND BLVD, DETROIT, MI 48202(313) 916-2600 Get Directions Write a Review

NPPES record last updated: April 19, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 19, 2024, Jul 6, 2022 (2 updates tracked since 2022).

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About Dr. Jordan Marie Jackson Md NPPES

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

DR. JORDAN MARIE JACKSON MD (NPI 1417680513) is an individual student in an organized health care education/training program in Detroit, Michigan and active in the NPI registry since July 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1417680513

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameDR. JORDAN MARIE JACKSONCredential: MD

Location Address2799 W GRAND BLVDDetroit, MI 48202-2608

Mailing Address2799 W Grand BlvdDetroit, MI 48202-2608 · (313) 916-2600

Phone(313) 916-2600

Sole ProprietorNo

Enumeration DateJuly 6, 2022

Last NPPES UpdateApril 19, 20242 updates tracked since enumeration

NPPES CertifiedApril 19, 2024

✔ NPI 1417680513 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

2799 W GRAND BLVD, Detroit, MI 48202

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jordan Marie Jackson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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.

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