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WAYNE JEFFERY JACKSON PA
NPI 1750387023
Physician Assistant - Medical in Potsdam, NY

Active since June 22, 2005PECOS Enrolled
50 LEROY ST, POTSDAM, NY 13676(315) 265-3300 Get Directions Write a Review

NPPES record last updated: March 31, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Wayne Jeffery Jackson Pa NPPES

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

WAYNE JEFFERY JACKSON PA (NPI 1750387023) is an individual medical provider in Potsdam, New York, licensed in New York (004496) and active in the NPI registry since June 2005. He is enrolled in Medicare PECOS and maintains a secondary practice location in Alexandria Bay.

NPPES Registry Identity

NPI1750387023
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameWAYNE JEFFERY JACKSONCredential: PA
Location Address50 LEROY STPotsdam, NY 13676-1786
Mailing Address50 Leroy StPotsdam, NY 13676-1786 · (315) 265-3300
Phone(315) 265-3300
Sole ProprietorNo
Enumeration DateJune 22, 2005
Last NPPES UpdateMarch 31, 2021
NPPES CertifiedMarch 31, 2021
✔ NPI 1750387023 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in NY · 004496
50 LEROY ST, Potsdam, NY 13676
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Secondary Practice Location 1

Location 14 Fuller Street, River HospitalAlexandria Bay, NY 13607 · Phone (315) 482-2511 · Fax (315) 482-4981

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Wayne Jeffery Jackson Pa 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.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Emergency department visit for problem of high severity 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
98 services92 patients
Emergency department visit for life threatening or functioning severity 99285
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
93 services90 patients
Emergency department visit for problem of moderate severity 99283
An emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.
56 services56 patients

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.

DR. ALEXANDRU A STOIAN MD
Internal Medicine (Cardiovascular Disease)
50 LEROY ST
POTSDAM, NY 13676
St. Lawrence County (315) 261-5920
NORTH STAR EMERGENCY PHYSICIANS, PC
Emergency Medicine
50 LEROY ST
POTSDAM, NY 13676
St. Lawrence County (315) 265-1120
BAKTASH BOOTORABI MD
Radiology (Diagnostic Radiology)
50 LEROY ST
POTSDAM, NY 13676
St. Lawrence County (315) 782-2620
ST. LAWRENCE CARDIOLOGY
Internal Medicine (Cardiovascular Disease)
50 LEROY ST
POTSDAM, NY 13676
St. Lawrence County (315) 261-5920
MICHAEL B WHITEHEAD P.A.
Physician Assistant (Medical)
50 LEROY ST
POTSDAM, NY 13676
St. Lawrence County (315) 265-3300
KARYN SULLIVAN PA
Emergency Medicine
50 LEROY ST
POTSDAM, NY 13676
St. Lawrence County (315) 782-2620
MS. NANCY RUTLEDGE NP
Nurse Practitioner
50 LEROY ST, CANTON POTSDAM HOSPITAL
POTSDAM, NY 13676
St. Lawrence County (315) 261-5500
DR. JAMES HUANG M.D.
Anesthesiology
50 LEROY ST
POTSDAM, NY 13676
St. Lawrence County (315) 265-3300

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 Wayne Jackson's NPI number?

The NPI number for Wayne Jackson is 1750387023. It was assigned to this individual provider in the NPPES registry on June 22, 2005.

Where is Wayne Jackson located?

Wayne Jackson practices at 50 Leroy St, Potsdam, NY 13676. The listed phone number is (315) 265-3300.

What is Wayne Jackson's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Wayne Jackson enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Wayne Jackson was last updated on March 31, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.