Active NPI
James Edward Jackson, M.D.
- Pediatrics Physician
- Morehead, KY
National Provider Identifier
1033279864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 14467
- Practice address
- 212 E Main St
Morehead, KY 40351-1620 - Phone
- (606) 784-8518
- Fax
- (606) 784-8899
- NPI assigned
- Dec 11, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 14467 | KY | Primary |
Addresses
Primary practice location
212 E Main St
Morehead, KY 40351-1620
Mailing address
212 E Main St
Morehead, KY 40351-1620
Phone (606) 784-8518
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64144678 | Medicaid | KY |
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 |
|---|---|---|---|
| 14467 | KY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309478400000",
"number": "1033279864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 E MAIN ST",
"city": "MOREHEAD",
"state": "KY",
"postal_code": "403511620",
"telephone_number": "606-784-8518",
"fax_number": "606-784-8899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 E MAIN ST",
"city": "MOREHEAD",
"state": "KY",
"postal_code": "403511620",
"telephone_number": "606-784-8518",
"fax_number": "606-784-8899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JAMES",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-11",
"last_updated": "2011-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "KY",
"license": "14467",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64144678",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Morehead, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.