MARY LUEBEN JACKSON PA-C
NPI 1720216203
Physician Assistant - Medical in Baltimore, MD
About Mary Lueben Jackson Pa-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MARY LUEBEN JACKSON PA-C (NPI 1720216203) is an individual medical provider in Baltimore, Maryland, licensed in Maryland (C0003990) and active in the NPI registry since June 2009. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mary Lueben Jackson Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
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.
BALTIMORE, MD 21237
BALTIMORE, MD 21237
BALTIMORE, MD 21237
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 Mary Jackson's NPI number?
The NPI number for Mary Jackson is 1720216203. It was assigned to this individual provider in the NPPES registry on June 23, 2009. The provider is also known as Mary Jesse Lueben Pa-C.
Where is Mary Jackson located?
Mary Jackson practices at 9000 Franklin Square Dr, Baltimore, MD 21237. The listed phone number is (443) 777-7046.
What is Mary Jackson's specialty?
The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.
Is Mary Jackson enrolled in Medicare?
Yes. Mary Jackson is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Mary Jackson was last updated on January 2, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Mary Lueben Jackson, PA-C · NPI 1720216203
Medical physician in Baltimore, Maryland. Individual provider, active in the CMS NPPES registry since June 23, 2009.
## Identity
- **NPI:** 1720216203 (Entity type: Individual)
- **Enumerated:** June 23, 2009
- **Primary specialty:** Physician Assistant - Medical · taxonomy 363AM0700X
- **State license:** C0003990 (Maryland)
- **Sole proprietor:** No
## Practice location
- **Address:** 9000 FRANKLIN SQUARE DR, Baltimore, MD 21237-3901
- **Phone:** (443) 777-7046
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** January 2, 2015
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Source: [NPI Profile](https://npiprofile.com/npi/1720216203) · Data from the CMS NPPES public registry.