Active NPI
Ivor Jackson, MD
- Endocrinology, Diabetes & Metabolism Physician
- Jupiter, FL
National Provider Identifier
1023089265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician
- License
- ME 86546
- Practice address
- 4600 Military Trail
Suite 218
Jupiter, FL 33458-4813 - Phone
- (561) 626-9041
- NPI assigned
- Jan 27, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | ME 86546 | FL | Primary |
Addresses
Primary practice location
4600 Military Trail
Suite 218
Jupiter, FL 33458-4813
Mailing address
PO Box 8474
Jupiter, FL 33468-8474
Phone (561) 626-9041
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9006212 | Medicaid | RI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 86546 | FL | MD | Endocrinology, Diabetes & Metabolism Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023089265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8474",
"city": "JUPITER",
"state": "FL",
"postal_code": "334688474",
"telephone_number": "561-626-9041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4600 MILITARY TRAIL",
"address_2": "SUITE 218",
"city": "JUPITER",
"state": "FL",
"postal_code": "334584813",
"telephone_number": "561-626-9041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "IVOR",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RE0101X",
"taxonomy_group": "",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "FL",
"license": "ME 86546",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9006212",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jupiter, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.