Active NPI
Bernice Boddie Jackson, M.D.
- Occupational Medicine Physician
- Los Angeles, CA
National Provider Identifier
1003146168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Medicine Physician
- License
- G37001
- Practice address
- 241 N. Figueroa St.
Los Angeles, CA 90012-2601 - Phone
- (213) 989-7168
- NPI assigned
- Jan 12, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Medicine Physician | 2083X0100X | G37001 | CA | Primary |
Addresses
Primary practice location
241 N. Figueroa St.
Los Angeles, CA 90012-2601
Mailing address
P.O. Box 19788
Los Angeles, CA 90019-0788
Phone (323) 938-6586
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G37001 | CA | MD | Occupational Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263254400000",
"number": "1003146168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 19788",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900190788",
"telephone_number": "323-938-6586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "241 N. FIGUEROA ST.",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900122601",
"telephone_number": "213-989-7168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BERNICE",
"middle_name": "BODDIE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-12",
"last_updated": "2010-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "CA",
"license": "G37001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.