Active NPI
Martha A Jackson, DPM
- Podiatrist
- North Little Rock, AR
National Provider Identifier
1053372946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 87
- Practice address
- 2501 Crestwood Rd
Suite 101
North Little Rock, AR 72116-7615 - Phone
- (501) 771-4785
- Fax
- (501) 771-4787
- NPI assigned
- Mar 30, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 87 | AR | Primary |
Addresses
Primary practice location
2501 Crestwood Rd
Suite 101
North Little Rock, AR 72116-7615
Mailing address
2501 Crestwood Rd
Suite 101
North Little Rock, AR 72116-7615
Phone (501) 771-4785
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16253000040 | Other | AR | QUAL CHOICE |
| 5997156 | Other | AETNA | |
| 0580220001 | Other | PALMETTO DME | |
| 9468520001 | Other | CIGNA | |
| 2720028 | Other | UNITED HEALTH CARE | |
| 56243 | Other | AR | FEP BCBS |
| 56243 | Other | AR | FIRST SOURCE |
| 56243 | Other | AR | AR BCBS |
| 56243 | Other | AR | HEALTH ADVANTAGE |
| 110420717 | Medicaid | AR |
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)
- Enrolled
Interoperability endpoints
- mjackson@cfcl-ar.direct.office.nextgen.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594684800000",
"number": "1053372946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2501 CRESTWOOD RD",
"address_2": "SUITE 101",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721167615",
"telephone_number": "501-771-4785",
"fax_number": "501-771-4787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 CRESTWOOD RD",
"address_2": "SUITE 101",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721167615",
"telephone_number": "501-771-4785",
"fax_number": "501-771-4787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARTHA",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-30",
"last_updated": "2020-07-14",
"certification_date": "2020-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "AR",
"license": "87",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUAL CHOICE",
"identifier": "16253000040",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5997156",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO DME",
"identifier": "0580220001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "9468520001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "2720028",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEP BCBS",
"identifier": "56243",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST SOURCE",
"identifier": "56243",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AR BCBS",
"identifier": "56243",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ADVANTAGE",
"identifier": "56243",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110420717",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.