Scott Eric Jackson, RT(R)(CT)

Primary specialty

Computed Tomography Radiologic TechnologistTaxonomy code 2471C3401X

License

R08214 Issued in MD

Practice address

655 Watkins Mill Rd
Gaithersburg, MD 20879-3301

Phone

(240) 632-4418

NPI assigned

Mar 30, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585526400000",
    "number": "1043848526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 WATKINS MILL RD",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793301",
            "telephone_number": "240-632-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 WATKINS MILL RD",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793301",
            "telephone_number": "240-632-4418"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8901 Rockville Pike Bldg 9A",
            "address_purpose": "LOCATION",
            "city": "Bethesda",
            "state": "MD",
            "postal_code": "208890001",
            "country_code": "US",
            "telephone_number": "301-295-4963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SCOTT",
        "middle_name": "ERIC",
        "name_prefix": "Mr.",
        "credential": "RT(R)(CT)",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-30",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2471C3402X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Radiography",
            "state": "MD",
            "license": "R08214",
            "primary": false
        },
        {
            "code": "2471C3401X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Computed Tomography",
            "state": "MD",
            "license": "R08214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Radiologic Technologist in Gaithersburg, MD
• Providers in Gaithersburg, MD by specialty
• Radiologic Technologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.

Verify at the official NPI Registry.