Active NPI
Joseph A Jackson, M.D.
- Neurology Physician
- Spanish Fort, AL
National Provider Identifier
1073633624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 25310
- Practice address
- 30941 Mill LN Ste G-132
Spanish Fort, AL 36527-5456 - Phone
- (228) 594-2000
- Fax
- (228) 357-9362
- NPI assigned
- Mar 29, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 08636 | MS | |
| Neurology Physician | 2084N0400X | 25310 | AL | Primary |
Addresses
Primary practice location
30941 Mill LN Ste G-132
Spanish Fort, AL 36527-5456
Mailing address
30941 Mill LN Ste G-132
Spanish Fort, AL 36527-5456
Phone (228) 594-2000
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
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25310 | AL | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Life Management Center of Northwest Florida Inc | Past | Accepting new patients | |
| Memorial Hospital at Gulfport | Past | Accepting new patients | |
| Stone County Hospital, Inc | Past | Accepting new patients | |
| Compass Health, Inc | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Compass Health Network
- Community/Behavioral Health Agency
- Clinton, MO
- NPI 1285619494
-
- Psychiatry Physician
- Blountstown, FL
- NPI 1659301877
-
dba Memorial Emergency Physicians
- Emergency Medicine Physician
- Gulfport, MS
- NPI 1962780379
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594080000000",
"number": "1073633624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30941 MILL LN STE G-132",
"city": "SPANISH FORT",
"state": "AL",
"postal_code": "365275456",
"telephone_number": "228-594-2000",
"fax_number": "228-357-9362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30941 MILL LN STE G-132",
"city": "SPANISH FORT",
"state": "AL",
"postal_code": "365275456",
"telephone_number": "228-594-2000",
"fax_number": "228-357-9362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JOSEPH",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-29",
"last_updated": "2020-07-07",
"certification_date": "2020-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MS",
"license": "08636",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "AL",
"license": "25310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spanish Fort, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.