Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1104072297 Individual Practitioner Male Practitioner

Derrell Glenn Jackson , PA-C

Physician Assistant • Colonial Heights, VA

Professional Overview & Biography Verified Profile Summary

Derrell Jackson, PA-C is a registered healthcare professional specializing in Physician Assistant in Colonial Heights, VA. Practice services are available at 436 CLAREMONT CT under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

436 Claremont Ct
Suite 100

Colonial Heights, VA 238341765

Telephone 8045262121
Fax 8045202617
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Colonial Heights, VA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 11.3 Yrs
State Avg: 10.5 Yrs
Regional Practice Density
15 Specialists

Practicing in Colonial Heights, VA (4432 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License VA 0110002804

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Physician Assistant - Medical

NUCC Taxonomy Code: 363AM0700X

State License VA 0110002804

Definition to come...

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
1104072297 (VA)
Commercial Insurance / Payer ID Optima
10040880P (VA)
Commercial Insurance / Payer ID Rr Medicare
P00685057 (VA)
Commercial Insurance / Payer ID Sentara Healthcare
10040880P (VA)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

11 Associated Practitioners
Dr. John Lewis , DO

Family Medicine

NPI 1003814005

Doctor of Osteopathic Medicine (D.O.)

Cynthia Booten , FNP

Nurse Practitioner

NPI 1003989351

Family Nurse Practitioner

Dr. Lonia Abbott , MD

Family Medicine

NPI 1134358138

Doctor of Medicine (M.D.)

Dr. John Yosay , MD

Family Medicine

NPI 1174784110

Doctor of Medicine (M.D.)

NPI 1245325729

Doctor of Medicine (M.D.)

Dr. Clark Hunt , MD

Family Medicine

NPI 1316937162

Doctor of Medicine (M.D.)

Career & Practice History Timeline

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

6 Historical Events
NPI Profile Active May 26, 2010

NPI status registered as active in NPPES database

📍
Updated Practice Location May 26, 2010

Registered at 436 CLAREMONT CT, SUITE 100, COLONIAL HEIGHTS, VA 238341765 (Tel: 8045262121)

📍
Updated Business Mailing Address May 26, 2010

Registered at 205 MISTY RIDGE LN, SUFFOLK, VA 234341516 (Tel: 7574067328)

👤
Provider Name / Credentials Updated May 26, 2010

Recorded as DERRELL JACKSON, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 26, 2010

Physician Assistant (License #0110002804 in VA)

🟢
Initial NPI Registration & Enumeration August 08, 2008

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: 1104072297
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 08, 2008
Last Update: May 26, 2010
Sole Proprietor: No

Mailing Address

205 Misty Ridge Ln

Suffolk, VA 234341516

Phone: 7574067328

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.