Active NPI
Mark H Jackson, MD
- Internal Medicine Physician
- Brooklyn, NY
National Provider Identifier
1043272974
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(2) exclusion effective Mar 18, 2021.
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 181595
- Practice address
- 1456 Fulton St
Brooklyn, NY 11216-2607 - Phone
- (718) 636-4500
- Fax
- (341) 729-6836
- NPI assigned
- Apr 5, 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 181595 | NY | Primary |
Addresses
Primary practice location
1456 Fulton St
Brooklyn, NY 11216-2607
Mailing address
1456 Fulton St
Brooklyn, NY 11216-2607
Phone (718) 636-4500
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335916800000",
"number": "1043272974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1456 FULTON ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112162607",
"telephone_number": "718-636-4500",
"fax_number": "341-729-6836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1456 FULTON ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112162607",
"telephone_number": "718-636-4500",
"fax_number": "341-729-6836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARK",
"middle_name": "H",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-05",
"last_updated": "2012-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "181595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.