DR. JACKIE MAE ANDERSON (NPI# 1447789565) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447789565 |
| Entity Type | Individual |
| Full Name | DR. JACKIE MAE ANDERSON |
| Other Name | MS. JACKIE MAE GRIMES |
| Credential | DO |
| Practice Address |
10800 Knights Rd Philadelphia PA 19114-4200 |
| Practice Telephone | 2156125161 |
| Mailing Telephone | 2156125161 |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2017-06-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
OT018082 | PA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295004406 | Jackie Lou Anderson | Developmental Therapist | 101 Shoreland Rd, Machesney Park, IL 61115-2833 | 2011-12-16 |
| 1477072437 | Jackie Lynn Anderson | Social Worker | 2116 Broadway, Oakland, CA 94612-2310 | 2017-09-11 |
| 1790132652 | Jackie Anderson | Family Medicine | 1010 N Kansas St, Wichita, KS 67214-3124 | 2016-05-20 |
| Street Address |
10800 KNIGHTS RD |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19114-4200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073508453 | John K Moran | Radiology | 10800 Knights Rd, Attn: Radiology, Philadelphia, PA 19114-4200 | 2005-09-13 |
| 1841898327 | Clayton Tyan Chiem | Nurse Anesthetist, Certified Registered | 10800 Knights Rd, Philadelphia, PA 19114-4200 | 2020-10-15 |
| 1932707130 | Melissa Yoon | Physician Assistant | 10800 Knights Rd, Philadelphia, PA 19114-4200 | 2020-10-12 |
| 1013534643 | Tyler Barrett Drury | Student in an Organized Health Care Education/Training Program | 10800 Knights Rd, Philadelphia, PA 19114-4200 | 2020-06-30 |
| 1932726809 | Marina Romany Tony | Student in an Organized Health Care Education/Training Program | 10800 Knights Rd, Philadelphia, PA 19114-4200 | 2020-06-26 |
| 1336766211 | Victoria Trovillion | Student in an Organized Health Care Education/Training Program | 10800 Knights Rd, Philadelphia, PA 19114-4200 | 2020-06-26 |
| 1932725165 | Kissa Walker | Student in an Organized Health Care Education/Training Program | 10800 Knights Rd, Philadelphia, PA 19114-4200 | 2020-06-23 |
| 1851917371 | Elana Roadcloud | Internal Medicine | 10800 Knights Rd, Philadelphia, PA 19114-4200 | 2020-06-20 |
| 1316563901 | Elizabeth Rose Chambers | Nurse Anesthetist, Certified Registered | 10800 Knights Rd, Philadelphia, PA 19114-4200 | 2020-06-19 |
| 1194341008 | Penelope Kagan | Student in an Organized Health Care Education/Training Program | 10800 Knights Rd, Philadelphia, PA 19114-4200 | 2020-06-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164029906 | Phuoc Nguyen | Nurse Anesthetist, Certified Registered | Jefferson Torresdale Hospital, 10800 Knights Rd, Philadelphia, PA 19114 | 2020-10-05 |
| 1053921932 | Priyanka Patel | Dentist | Philadelphia Dental Smiles, 9140 Academy Road, Philadelphia, PA 19114 | 2020-08-05 |
| 1215419080 | Thomas Patrick Gallagher | Specialist/Technologist | 2708 Ruth Way, Philadelphia, PA 19114 | 2018-08-29 |
| 1558840223 | Alexis Wenger | Early Intervention Provider Agency | 3810 Aubrey Ave, Phila, PA 19114 | 2018-08-13 |
| 1245759232 | Newlands Health | Clinic/Center | 9625 Frankford Ave., Philadelphia, PA 19114 | 2017-09-12 |
| 1619491453 | Nazareth Physician Services Inc | Social Worker | 9815 Roosevelt Blvd Ste G, Philadelphia, PA 19114 | 2017-08-02 |
| 1326561606 | L.s. Share & Love Support Coordinating Agency, LLC | Case Management | 3600 Red Lion Road, Apt 68c, Philadelphia, PA 19114 | 2017-07-19 |
| 1760911952 | Charles C Richards II | Counselor | 2555 Welsh Rd, Apt 407, Philadelphia, PA 19114 | 2017-06-09 |
| 1801338686 | April Neuls | Physical Therapy Assistant | 4213 Lackland Place, Philadelphia, PA 19114 | 2016-11-10 |
| 1114317583 | Siji Cyriac | Physical Therapist | 9501 State Road, Philadelphia, PA 19114 | 2015-01-23 |
| Find all providers in zip 19114 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477711190 | Brian J Clohessy | Emergency Medicine | Red Lion and Knights Road, Frankford Hospital, Philadelphia, PA 19114 | 2008-05-29 |
| 1720272818 | Maggie Beams | Emergency Medicine | 1218 Walnut St Apt 1003, Philadelphia, PA 19107-5446 | 2007-08-31 |
| 1114525367 | Madison Brannon | Emergency Medicine | 3900 Woodland Ave, Philadelphia, PA 19104-4551 | 2020-10-10 |
| 1114542263 | Sean Paul Paul Schlosser | Emergency Medicine | 3401 N Broad St, Philadelphia, PA 19140-5189 | 2020-06-15 |
| 1164915682 | Matthew Berger | Emergency Medicine | 3401 N Broad St, Philadelphia, PA 19140-5103 | 2018-06-09 |
| 1710367974 | Jean-gabriel Coignet | Emergency Medicine | 5501 Old York Rd Ste 1, Philadelphia, PA 19141-3098 | 2015-06-03 |
| 1619315090 | Emily M Hatke | Emergency Medicine | 10800 Knights Rd, Philadelphia, PA 19114-4200 | 2013-06-07 |
| 1093095887 | Matthew William Hammond | Emergency Medicine | 10800 Knights Rd, Philadelphia, PA 19114-4200 | 2011-08-24 |
| 1801183678 | Carl Alec Alsup | Emergency Medicine | 1020 Sansom St Ste 239, Thompson Building, Philadelphia, PA 19107-5002 | 2011-06-30 |
| 1649434846 | Matthew Jones | Emergency Medicine | 1400 Broad St, Department of Emergency Medicine, Philadelphia, PA 19107 | 2008-07-16 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.