NPIMap

Individual provider Active NPI

Anthony Earle Jackson

  • Geriatric Medicine (Internal Medicine) Physician
  • Kansas City, MO
National Provider Identifier
1063076925
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
2022048175 Issued in MO
Practice address
4321 Washington St
Kansas City, MO 64111-5905
Phone
(816) 932-3100
NPI assigned
Apr 26, 2019
Last updated
Aug 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 2022048175 MO Primary

Addresses

Primary practice location

4321 Washington St
Kansas City, MO 64111-5905

Mailing address

4321 Washington St
Kansas City, MO 64111-5905
Phone (816) 932-3100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230802000365 MO Practitioner - Internal Medicine 1951636554 Reassigns benefits to 1 organization
I20230920003889 KS Practitioner - Internal Medicine 1951636554 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Kansas School of Med (KC/Wich/Sal), 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saint Lukes Physician Group IncGroup PAC ID 3577476894, 1,233 clinicians

Practice addresses (Care Compare)

4061 Indian Creek Pkwy
Overland Park, KS 66207-4030
Phone (816) 932-4630

4321 Washington
3000 Saint Luke's Internal Medicine
Kansas City, MO 64111-5928
Phone (816) 932-3100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Luke's Physician Group Inc CurrentSince Jul 17, 2023 Accepting new patients
Saint Luke's Physician Group I, LLC Past Accepting new patients
The Bishop Spencer Place, Inc. Past Accepting new patients

Locations

711 Marshall St
Leavenworth, KS 66048
Phone (913) 684-1100

12330 Metcalf Ave
Ste 500A
Overland Park, KS 66213
Phone (913) 323-9000

4061 Indian Creek Pkwy
Overland Park, KS 66207
Phone (913) 323-4600

4301 Madison Ave
Kansas City, MO 64111
Phone (816) 595-5007

901 E 104th St
Ste 400
Kansas City, MO 64131
Phone (816) 502-8752

601 S US Highway 169
Smithville, MO 64089
Phone (816) 532-3999

Interoperability endpoints

  • Direct secure messaging: ajackson627398@direct.saint-lukes.org
  • FHIR API: https://epicmobile.corp.saint-lukes.org/FHIRPROXY/api/FHIR/R4

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Bishop Spencer Place IncKansas City, MO, CCN 265768 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
Dec 9, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1556236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1063076925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4321 WASHINGTON ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641115905",
            "telephone_number": "816-932-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4321 WASHINGTON ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641115905",
            "telephone_number": "816-932-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANTHONY",
        "middle_name": "EARLE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-26",
        "last_updated": "2023-08-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MO",
            "license": "2022048175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.