Active NPI
Adam Jackson, BMSCD, MBSC, CNIM
- Sleep Specialist (PhD)
- Chicago, IL
National Provider Identifier
1023558376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sleep Specialist (PhD)
- Practice address
- 55 W Chestnut St
Chicago, IL 60610-3347 - Phone
- (615) 732-9343
- NPI assigned
- Mar 6, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Electrodiagnostic Medicine Physician | 204R00000X | 2045 | IL | |
| Clinical Neurophysiology Physician | 2084N0600X | 2045 | TN | |
| Sleep Specialist (PhD) | 173F00000X | Primary |
Addresses
Primary practice location
55 W Chestnut St
Chicago, IL 60610-3347
Mailing address
55 W Chestnut St Apt 2208
Chicago, IL 60610-3345
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2045 | IL | MD | Electrodiagnostic Medicine Physician |
| 2045 | TN | MD | Registered Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587772800000",
"number": "1023558376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 W CHESTNUT ST APT 2208",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606103345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 W CHESTNUT ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606103347",
"telephone_number": "615-732-9343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ADAM",
"name_prefix": "Dr.",
"credential": "BMSCD, MBSC, CNIM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-06",
"last_updated": "2020-04-25",
"certification_date": "2020-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "204R00000X",
"taxonomy_group": "",
"desc": "Electrodiagnostic Medicine",
"state": "IL",
"license": "2045",
"primary": false
},
{
"code": "2084N0600X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Clinical Neurophysiology",
"state": "TN",
"license": "2045",
"primary": false
},
{
"code": "173F00000X",
"taxonomy_group": "",
"desc": "Sleep Specialist, PhD",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.