ALFRED VAUGHN DERISE JACKSON JR. MD
NPI 1609189695
Family Medicine in Knoxville, TN
About Alfred Vaughn Derise Jackson Jr. Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ALFRED VAUGHN DERISE JACKSON JR. MD (NPI 1609189695) is an individual family medicine provider in Knoxville, Tennessee, licensed in Tennessee (50821) and active in the NPI registry since July 2010. He is enrolled in Medicare PECOS, is affiliated with Roane Medical Center, and is a graduate of Other (2010).
NPPES Registry Identity
Specialties & Licenses 3
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Alfred Vaughn Derise Jackson Jr. 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.
Medicare Billing Reassignments
2Medicare enrollment records show Alfred Jackson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Newport, TN 37821
- Reassigned Medicare billing, Tennessee enrollment
- 664 clinicians in this Medicare group
Maysville, KY 41056
- Reassigned Medicare billing, Tennessee enrollment
- 1,071 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Roane Medical Center
Acute Care Hospitals · Harriman, TNClaiborne Medical Center
Acute Care Hospitals · Tazewell, TNPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 37909 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 4
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
KNOXVILLE, TN 37909
KNOXVILLE, TN 37909
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 Alfred Jackson's NPI number?
The NPI number for Alfred Jackson is 1609189695. It was assigned to this individual provider in the NPPES registry on July 19, 2010.
Where is Alfred Jackson located?
Alfred Jackson practices at 930 Adell Ree Park Ln, Knoxville, TN 37909. The listed phone number is (865) 769-2600.
What is Alfred Jackson's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Alfred Jackson enrolled in Medicare?
Yes. Alfred Jackson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Alfred Jackson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Alfred Jackson reassigns Medicare benefits to 2 organizations: Emergency Coverage, LLC (Newport, TN) and Southeastern Emergency Physicians LLC (Maysville, KY). Each 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 Alfred Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Alfred Jackson affiliated with any hospitals?
According to CMS data, Alfred Jackson is affiliated with Roane Medical Center and Claiborne Medical Center.
When was this NPI record last updated?
The NPPES record for Alfred Jackson was last updated on March 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# Alfred Vaughn Derise Jackson Jr., MD · NPI 1609189695
Family Medicine physician in Knoxville, Tennessee. Individual provider, active in the CMS NPPES registry since July 19, 2010.
## Identity
- **NPI:** 1609189695 (Entity type: Individual)
- **Enumerated:** July 19, 2010
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** 50821 (Tennessee)
- **Sole proprietor:** No
## Practice location
- **Address:** 930 ADELL REE PARK LN, Knoxville, TN 37909-2543
- **Phone:** (865) 769-2600
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Emergency Coverage, LLC (NPI 1427005008, Newport, TN); Southeastern Emergency Physicians LLC (NPI 1356379382, Maysville, KY) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2010
## Record status
- **NPPES last updated:** March 23, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1609189695) · Data from the CMS NPPES public registry.