NPIMap

Organization Active NPI

Jackson Medical Services

Doing business as Prestige Medical Rejuvenation Center

  • General Practice Physician
  • Omaha, NE
National Provider Identifier
1033769559
Registry record updated Nov 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
JACKSON MEDICAL SERVICES
Doing business as
Prestige Medical Rejuvenation Center
Practice address
17650 Wright St Ste 5
Omaha, NE 68130-2800
Phone
(402) 334-5433
Fax
(402) 333-1037
NPI assigned
Sep 17, 2019
Last updated
Nov 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2019

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

Authorized official

Name
Darin E Jackson, MDNPI 1265567267
Title
Owner
Phone
(402) 334-5433

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

17650 Wright St Ste 5
Omaha, NE 68130-2800

Mailing address

17650 Wright St Ste 5
Omaha, NE 68130-2800
Phone (402) 334-5433

Other names 1

  • Prestige Medical Rejuvenation Center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573430400000",
    "number": "1033769559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17650 WRIGHT ST STE 5",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302800",
            "telephone_number": "402-334-5433",
            "fax_number": "402-333-1037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17650 WRIGHT ST STE 5",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302800",
            "telephone_number": "402-334-5433",
            "fax_number": "402-333-1037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-17",
        "last_updated": "2019-11-11",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DARIN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-334-5433",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prestige Medical Rejuvenation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prestige Medical Rejuvenation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.