Active NPI
Lorren Jackson, M.D.
- Forensic Pathology Physician
- Minneapolis, MN
National Provider Identifier
1073725321
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Pathology Physician
- License
- 52249
- Practice address
- 530 Chicago Ave
Minneapolis, MN 55415-1518 - Phone
- (612) 215-6300
- NPI assigned
- May 7, 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 |
|---|---|---|---|---|
| Forensic Pathology Physician | 207ZF0201X | 52249 | MN | Primary |
| Anatomic Pathology Physician | 207ZP0101X | A86673 | CA |
Addresses
Primary practice location
530 Chicago Ave
Minneapolis, MN 55415-1518
Mailing address
530 Chicago Ave
Minneapolis, MN 55415-1518
Phone (612) 215-6300
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52249 | MN | MD | Forensic Pathology Physician |
| A86673 | CA | MD | Anatomic Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415750400000",
"number": "1073725321",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554151518",
"telephone_number": "612-215-6300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554151518",
"telephone_number": "612-215-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LORREN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-07",
"last_updated": "2014-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "207ZF0201X",
"taxonomy_group": "",
"desc": "Pathology, Forensic Pathology",
"state": "MN",
"license": "52249",
"primary": true
},
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "CA",
"license": "A86673",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.