Douglas Jackson, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036057410 Issued in IL

Practice address

934 Center St
Elgin, IL 60120-2125

Phone

(847) 429-8750

Fax

(847) 429-8978

NPI assigned

Jul 14, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Elgin, IL
  • NPI 1912283110
  Medicare reassignment NPD
• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Springfield, IL
  • NPI 1871360297
  NPD
• Cepamerica Illinois LLP

  • Family Medicine Physician
  • Elgin, IL
  • NPI 1962789834

  Emergency Medicine

  NPD
• Greater Elgin Emergency Specialists LTD

  • Emergency Medicine Physician
  • Elgin, IL
  • NPI 1134152366
  NPD (past)

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083612857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 QUAIL RIDGE DR",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605596142",
            "telephone_number": "630-321-8300",
            "fax_number": "630-321-8750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "934 CENTER ST",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601202125",
            "telephone_number": "847-429-8750",
            "fax_number": "847-429-8978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036057410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03607410",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "04532206",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Arcangelo M. Iusco, MD
• Matthew Alexis Ivanovich, M.D.
• Beverly Yvonne Ivy
• Srinivasan Krishna Iyer, BA
• Christina Jackson, ACNS
• Elizabeth Anne Jackson, LSW
• Robert Jackson
• Shaletha Jackson
• Velma Jackson
• Jacob-Charly Medical.PLLC

• Emergency Medicine Physician in Elgin, IL
• Providers in Elgin, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.