Michael Reid Jackson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0019523 Issued in WA

Practice address

5350 Orchard St W
Suite 202
University Place, WA 98467-4817

Phone

(253) 472-4444

Fax

(253) 301-4360

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

State licenses

Practice roles

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.

• Michael R. Jackson, M.D. P.S.

  • Family Medicine Physician
  • University Place, WA
  • NPI 1366701849
  NPD Authorized official
• Emerson Dental Inc PC

  dba Emerson Dental

  • Dental Clinic/Center
  • Fircrest, WA
  • NPI 1548013014
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395100800000",
    "number": "1043239429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5350 ORCHARD ST W",
            "address_2": "SUITE 202",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984674817",
            "telephone_number": "253-472-4444",
            "fax_number": "253-401-4360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5350 ORCHARD ST W",
            "address_2": "SUITE 202",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984674817",
            "telephone_number": "253-472-4444",
            "fax_number": "253-301-4360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHAEL",
        "middle_name": "REID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2014-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "0019523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1077510",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Integrity Healthcare of Wa LLC
• Integrity Transportation
• J Mark Burnett DDS PS
• Gordon Jablonski
• Clara Rose Jackson, DPT
• Shelly Arlene Jackson, RN60434660
• Kristen Jacob, LMT
• Kelsey Jo Jacobi, MSP
• Jose Manuel Jaime
• Jakika Adult Family Home, LLC

• Family Medicine Physician in University Place, WA
• Providers in University Place, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; 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.