Mark A Jackson, MD

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

4301051555 Issued in MI

Practice address

1000 Pavilions Circle
Mark a Jackson MD PLC
Traverse City, MI 49684

Phone

(231) 935-0913

Fax

(231) 935-0984

NPI assigned

Feb 2, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445558400000",
    "number": "1073585238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10850 E TRAVERSE HWY",
            "address_2": "STE 4400",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496841364",
            "telephone_number": "231-346-6930",
            "fax_number": "231-346-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 PAVILIONS CIRCLE",
            "address_2": "MARK A JACKSON MD PLC",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-935-0913",
            "fax_number": "231-935-0984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2015-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "051555",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "4301051555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1820487",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "080B86010",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J B Zoutendam DDS PC
• J Weber Medical Group PLLC
• J. Donberg, LLC
• J. Eric Zimmerman, M.D., P.C.
• Jordan Jabara, MD
• Matthew R Jackson, D.O.
• Neil Bradley Jackson, DC
• Nicole Marie Jackson, BT
• Sarah Kristen Jackson, MS
• Jacob White PH.D., PLLC

• Geriatric Medicine (Family Medicine) Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Geriatric Medicine (Family Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; 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.