Active NPI
Antione Jackson
- Counselor
- Seattle, WA
National Provider Identifier
1043821754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 909 4TH Ave
Seattle, WA 98104-1108 - Phone
- (206) 382-5000
- NPI assigned
- Aug 14, 2020
- Last updated
- Aug 17, 2020
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
909 4TH Ave
Seattle, WA 98104-1108
Mailing address
32614 10TH PL SW
Federal Way, WA 98023-4900
Phone (206) 877-2118
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | ycs@seattleymca.org | Direct |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health Home Program | Past | Accepting new patients | |
| The Young Mens Christian Association of Greater Seattle | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- Seattle, WA
- NPI 1831699131
-
- Health Educator
- Seattle, WA
- NPI 1962526046
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597622400000",
"number": "1043821754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32614 10TH PL SW",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980234900",
"telephone_number": "206-877-2118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "909 4TH AVE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981041108",
"telephone_number": "206-382-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ANTIONE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-14",
"last_updated": "2020-08-17",
"certification_date": "2020-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "ycs@seattleymca.org",
"affiliation": "N",
"endpointDescription": "ycs@seattleymca.org",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Services",
"address_1": "909 4th Ave",
"city": "Seattle",
"state": "WA",
"country_code": "US",
"postal_code": "981041108",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.