LYNDON JACKSON JR.
NPI 1467394478
Nurse Practitioner in Dorchester, MA

Q: What is Lyndon Jackson's NPI number?

The NPI number for Lyndon Jackson is 1467394478. It was assigned to this individual provider in the NPPES registry on April 8, 2026.

Q: What is Lyndon Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Lyndon Jackson was last updated on May 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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 April 08, 2026PECOS Enrolled

637 WASHINGTON ST, DORCHESTER, MA 02124(617) 825-9660 Get Directions Write a Review

NPPES record last updated: May 1, 2026. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: May 1, 2026, Apr 8, 2026 (2 updates tracked since 2026).

On this page

About Lyndon Jackson Jr. NPPES

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

LYNDON JACKSON JR. (NPI 1467394478) is an individual nurse practitioner in Dorchester, Massachusetts, licensed in Massachusetts (RN2379126) and active in the NPI registry since April 2026. He is enrolled in Medicare PECOS and is a graduate of Other (2026).

NPPES Registry Identity

NPI1467394478

Entity TypeIndividualMale

Primary Taxonomy363L00000X

Provider Legal NameLYNDON JACKSON JR.

Location Address637 WASHINGTON STDorchester, MA 02124-3510

Mailing Address637 Washington StDorchester, MA 02124-3510 · (617) 825-9660

Phone(617) 825-9660

Sole ProprietorNo

Medical School CMSOtherGraduated 2026

Enumeration DateApril 8, 2026

Last NPPES UpdateMay 1, 20262 updates tracked since enumeration

NPPES CertifiedMay 1, 2026

✔ NPI 1467394478 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in MA · RN2379126

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedRegistered Nurse · OncologyTaxonomy 163WX0200X · License RN2379126 (MA)

637 WASHINGTON ST, Dorchester, MA 02124

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lyndon Jackson Jr. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8022574318

PECOS Enrollment IDI20260727004475

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.

Medicare Billing Reassignment

Medicare enrollment records show Lyndon Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Codman Square Health Center Inc

Same address

Community Health

637 WASHINGTON ST
Dorchester Center, MA 02124

Reassigned Medicare billing, Massachusetts enrollment
91 clinicians in this Medicare group

NPI 1396808309 (617) 825-9660

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02124 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

$97.64 typical visit price

range $63.72 – $189.86

Typical copayment $24.41 (range $15.93 – $47.46)

Most-billed visit code 99203

Established Patient

$111.18 typical visit price

range $21.07 – $155.29

Typical copayment $27.79 (range $5.26 – $38.82)

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.

MIA ISABEL RODRIGUEZ DDS

Student in an Organized Health Care Education/Training Program

637 WASHINGTON ST
DORCHESTER, MA 02124

Suffolk County (617) 825-9660

DR. MARK CYPRIAN BEAUMONT MD

Family Medicine

637 WASHINGTON ST
DORCHESTER CENTER, MA 02124

Suffolk County (617) 825-9660

SHANNON LYONS RN, FNP

Nurse Practitioner (Family)

637 WASHINGTON ST
BOSTON, MA 02124

Suffolk County (617) 825-9660

MS. MARIE ANDREE PIERRE-VICTOR MSW, LICSW

Social Worker

637 WASHINGTON ST
DORCHESTER CENTER, MA 02124

Suffolk County (617) 822-8211

JENNIFER GARLIN LCSW

Social Worker

637 WASHINGTON ST
DORCHESTER CENTER, MA 02124

Suffolk County (617) 825-9660

MS. DENISE MARIE CROKEN NP

Nurse Practitioner (Family)

637 WASHINGTON ST
DORCHESTER, MA 02124

Suffolk County (617) 825-9660

BOSTON MEDICAL CENTER CORPORATION

Pharmacy (Community/Retail Pharmacy)

637 WASHINGTON ST
DORCHESTER, MA 02124

Suffolk County (617) 638-8150

BOSTON MEDICAL CENTER CORPORATION

Pharmacy (Community/Retail Pharmacy)

637 WASHINGTON ST
DORCHESTER, MA 02124

Suffolk County (617) 638-8150

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 Lyndon Jackson's NPI number?

The NPI number for Lyndon Jackson is 1467394478. It was assigned to this individual provider in the NPPES registry on April 8, 2026.

Where is Lyndon Jackson located?

Lyndon Jackson practices at 637 Washington St, Dorchester, MA 02124. The listed phone number is (617) 825-9660.

What is Lyndon Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Lyndon Jackson enrolled in Medicare?

Yes. Lyndon Jackson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Lyndon Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Lyndon Jackson reassigns Medicare benefits to Codman Square Health Center Inc (Dorchester Center, MA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Lyndon Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Lyndon Jackson was last updated on May 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.