Phillip Jackson, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

J4864 Issued in TX

Practice address

4609 Schwerin Lake Dr
Corpus Christi, TX 78413-5255

Phone

(361) 808-9383

Fax

(361) 808-9383

NPI assigned

Jan 25, 2006

Last updated

Aug 2, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/7f96711f-afb0-4764-969a-c5d57fe30c59/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Concord Medical Group of Texas PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1750790762
  Medicare reassignment NPD
• Concord Medical Group PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1083630610
  Medicare reassignment NPD
• Ghep Corpus Christi PLLC

  • Emergency Medicine Physician
  • Corpus Christi, TX
  • NPI 1174511133
  NPD (past)
• Odessa Physician Associates, PLLC

  • Emergency Medicine Physician
  • Odessa, TX
  • NPI 1457398364
  NPD (past)
• Odessa Regional Hospital LP

  • General Acute Care Hospital
  • Odessa, TX
  • NPI 1801852736
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280707200000",
    "number": "1023088895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4609 SCHWERIN LAKE DR",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784135255",
            "telephone_number": "361-808-9383",
            "fax_number": "361-808-9383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4609 SCHWERIN LAKE DR",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784135255",
            "telephone_number": "361-808-9383",
            "fax_number": "361-808-9383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2010-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "J4864",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J4864",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna G Jackson, FNP MSN
• James Richard Jackson, PA-C
• Joel Jackson, LPC,CPO
• Leah Jackson, PTA
• Paul Jackson, DO
• Taylor Catherine Jackson
• Jacob J Moore MD PA (Coastal Bend Eye Center)
• Jacob M Thompson DDS PC
• Nikhita Susan Jacob
• Jessie Pruett Jacobs, DMD

• Emergency Medicine Physician in Corpus Christi, TX
• Providers in Corpus Christi, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.