Alfred Vaughn Derise Jackson Jr, MD in Knoxville, TN

Alfred Vaughn Derise Jackson Jr, MD is a medicare enrolled "Family Medicine" physician in Knoxville, Tennessee. His current practice location is 930 Adell Ree Park Ln, Knoxville, Tennessee. You can reach out to his office (for appointments etc.) via phone at (865) 769-2600.

Alfred Vaughn Derise Jackson Jr is licensed to practice in Tennessee (license number 50821) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1609189695.

Contact Information

	Alfred Vaughn Derise Jackson Jr, MD
	930 Adell Ree Park Ln, Knoxville, TN 37909-2543
	(865) 769-2600
	Not Available

Map and Direction

Physician's Profile

Full Name	Alfred Vaughn Derise Jackson Jr
Gender	Male
Speciality	Family Medicine
Location	930 Adell Ree Park Ln, Knoxville, Tennessee
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1609189695
Provider Enumeration Date: 07/19/2010
Last Update Date: 03/23/2023

Medicare PECOS Information:

PECOS PAC ID: 8325280985
Enrollment ID: I20240605003132

Medical Identifiers

Medical identifiers for Alfred Vaughn Derise Jackson Jr such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1609189695	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207P00000X	Emergency Medicine	50821 (Tennessee)	Secondary
390200000X	Student In An Organized Health Care Education/training Program	(* (Not Available))	Secondary
207Q00000X	Family Medicine	50821 (Tennessee)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Alfred Vaughn Derise Jackson Jr allows following entities to bill medicare on his behalf.

Entity Name	Westbrook Medical Center, Pllc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1598893166 PECOS PAC ID: 4880637511 Enrollment ID: O20050603000719

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Alfred Vaughn Derise Jackson Jr is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Alfred Vaughn Derise Jackson Jr, MD 930 Adell Ree Park Ln, Knoxville, TN 37909-2543 Ph: (865) 769-2600	Alfred Vaughn Derise Jackson Jr, MD 930 Adell Ree Park Ln, Knoxville, TN 37909-2543 Ph: (865) 769-2600

Reviews and Comments

Family Medicine Doctors in Knoxville, TN

Dr. Dennis R. King, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 11416 Grigsby Chapel Rd Ste 102, Knoxville, TN 37934 Phone: 865-392-1717 Fax: 865-392-1719
Jonathan Andrew Towe, Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 7326 Maynardville Pike Ste 400, Knoxville, TN 37938 Phone: 865-925-9035 Fax: 865-925-9045
James Stacy Hicks, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1300 Old Weisgarber Rd, Knoxville, TN 37909 Phone: 865-584-2146 Fax: 865-584-9660
Dr. Priya Raghavan, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 3336 South Cir, Knoxville, TN 37920 Phone: 865-577-0320 Fax: 865-573-9544
Lance Morehead, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 9303 Park West Blvd, Ste 100, Knoxville, TN 37923 Phone: 865-690-6451
Dr. Chang Wen Chen, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 10430 Lovell Center Dr, Knoxville, TN 37922 Phone: 865-693-6882 Fax: 865-693-2909
Adam Christopher Lett, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 7211 Wellington Dr, Suite 201, Knoxville, TN 37919 Phone: 865-584-5762 Fax: 865-584-3403

Alfred Vaughn Derise Jackson Jr, MD - Medicare Family Medicine in Knoxville, TN