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Deactivated NPI 1700951993 Deactivated / Inactive NPI Male Practitioner

Dr. Michaelis B Jackson , MD

Ophthalmology • Herrin, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Michaelis Jackson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 22, 2006
NPI Deactivation Date June 15, 2018
Total Practice Duration ~12 Years of Practice (2006 – 2018)

Professional Overview & Biography Verified Profile Summary

Dr. Michaelis Jackson, MD was a registered Ophthalmology practicing in Herrin, IL. Throughout an active medical career spanning 12 years, Dr. Jackson provided care at the practice location at 500 LINCOLN DRIVE until profile deactivation on 2018-06-15.

Historical Medicare Part B clinical services included established patient complete exam of visual system, imaging of retina, established patient outpatient office visit. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

500 Lincoln Drive
Suite A

Herrin, IL 62948

Telephone 6189931969
Fax 6189931750

Specialty Benchmarks & Practice Insights

Comparative analytics for Ophthalmology in Herrin, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 31.1 Yrs
Regional Practice Density
1 Specialists

Practicing in Herrin, IL (954 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
60.9% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2018)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
92014 Established patient complete exam of visual system
972 882 $194.23 $120.67
92134 Imaging of retina
969 870 $150.00 $39.64
99213 Established patient office or other outpatient visit, typically 15 minutes
133 115 $79.29 $70.89
92133 Imaging of optic nerve
90 89 $150.00 $35.17
66984 Removal of cataract with insertion of lens
81 42 $877.24 $624.23
92083 Exam of visual field with extended testing
79 79 $133.14 $60.84
92136 Measurement of corneal curvature and depth of eye
77 46 $232.80 $52.50
92004 New patient complete exam of visual system
72 72 $235.00 $144.05
66821 Removal of recurring cataract in lens capsule using a laser
69 68 $1480.30 $377.37
92225 Examination of eye by ophthalmoscope with retinal drawing
34 17 $105.00 $26.30
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional
29 18 $35.00 $20.53
92012 Established patient problem focused exam of visual system
25 23 $130.85 $83.91
92250 Photography of the retina
23 22 $125.00 $54.22
92285 Photography of content of eyes
22 21 $75.00 $19.32
65855 Laser repair to improve eye fluid flow
18 12 $1105.13 $239.25
67820 Removal of eyelashes using forceps
15 14 $145.00 $37.38
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more
13 12 $52.98 $42.00
92002 New patient problem focused exam of visual system
12 12 $135.00 $79.98

Medical Specialties & State Licenses

Ophthalmology Primary Specialty

NUCC Taxonomy Code: 207W00000X

State License IL 036073298

An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated June 15, 2018

Record deactivated on June 15, 2018

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 500 LINCOLN DRIVE, SUITE A, HERRIN, IL 62948 (Tel: 6189931969)

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Updated Business Mailing Address July 08, 2007

Registered at 2800 W MAIN, CARBONDALE, IL 62901 (Tel: 6183518900)

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Provider Name / Credentials Updated July 08, 2007

Recorded as MICHAELIS JACKSON, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Ophthalmology (License #036073298 in IL)

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Initial NPI Registration & Enumeration November 22, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1700951993
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 22, 2006
Last Update: July 08, 2007
Deactivation Date: June 15, 2018

Mailing Address

2800 W Main

Carbondale, IL 62901

Phone: 6183518900

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.