Look up the most recent NPI and PECOS records

Pamela E Jackson

Internal Medicine

Allopathic & Osteopathic Physicians

4001 Coliseum Dr Ste 300, Hampton, VA 23666-6257

(757) 827-2025

PECOS Enrollment

This provider is enrolled in PECOS as PAMELA JACKSON.

Based on the most recent information from CMS, provider Pamela E Jackson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 11:47 AM.

Profile Details

Provider ID
1811091960
Provider Type
Individual
Full Name
Jackson, Pamela E
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
9/11/2006
Last Updated
12/6/2023

Contact Information

Practice Location

4001 Coliseum Dr Ste 300, Hampton, VA 23666-6257

(757) 827-2025

(757) 275-9802

Mailing Location

4001 Coliseum Dr Ste 300, Hampton, VA 23666-6257

(757) 827-2025

(757) 275-9802

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 0101271362 Virginia
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License 035139 Connecticut

Provider Identifiers

ID	Description	Issuer
ID 004235736	Description Other	Issuer COMMUNITY HEALTH NETWORK
ID 3171723	Description Other	Issuer AETNA
ID 10Q3466	Description Other	Issuer HEALTHNET
ID 010035139CT03	Description Other	Issuer ANTHEM BLUE CROSS BLUE SH
ID P3597371	Description Other	Issuer OXFORD
ID 035139	Description Other	Issuer CT CARE
ID 004235736	Description Medicaid	Issuer Unlisted Connecticut

Pamela E Jackson

PECOS Enrollment

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