NPIMap

Individual provider Active NPI

Andrew Thomas Jackson, M.D.

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Ozark, MO
National Provider Identifier
1093056988
Registry record updated Oct 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
2023005796 Issued in MO
Practice address
3050 E River Bluff Blvd
Ozark, MO 65721-8807
Phone
(417) 820-5610
NPI assigned
Mar 3, 2013
Last updated
Oct 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 081265 GA
Orthopaedic Surgery Physician 207X00000X 52399 SC
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 2023005796 MO Primary

Addresses

Primary practice location

3050 E River Bluff Blvd
Ozark, MO 65721-8807

Mailing address

210 E Derenne Ave
Savannah, GA 31405-6736
Phone (912) 644-5300

Other practice location 1

166 Memorial Dr
Jesup, GA 31545-0101
Phone (912) 427-0800

Other practice location 2

1061 Harmon Ave
Fort Stewart, GA 31314-5641
Phone (912) 435-6965

Other practice location 3

602 E Long St
Claxton, GA 30417-5914
Phone (912) 739-3275

Other practice location 4

8 N Williams St
Metter, GA 30439-4547
Phone (912) 685-3550

Other practice location 5

810 Towne Park Dr Ste 200
Rincon, GA 31326-5167
Phone (912) 826-2533

Other practice location 6

101 W Mulberry Blvd, Ste 140
Pooler, GA 31322
Phone (912) 748-5111

Other practice location 7

16915 Highway 67 Ste A
Statesboro, GA 30458-5819
Phone (912) 681-2500

Other practice location 8

60 Exchange St Ste B1
Richmond Hill, GA 31324-7646
Phone (912) 756-2273

Other practice location 9

210 E DeRenne Ave
Savannah, GA 31405-6736
Phone (912) 644-5300

Other identifiers 2

IdentifierTypeStateIssuer
523990MedicaidSC
003209886AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, MA, MO3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20181025003153 GA Practitioner - Orthopedic Surgery 8729309042 Reassigns benefits to 1 organization
I20220803000707 MA Practitioner - Orthopedic Surgery 8729309042 Reassigns benefits to 1 organization
I20230905002369 MO Practitioner - Orthopedic Surgery 8729309042 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Missouri, Columbia School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

3050 E River Bluff Blvd
MC Orthopedics
Ozark, MO 65721-8807
Phone (417) 820-5610

940 W Mount Vernon St
110 MC Imaging Services Nixa
Nixa, MO 65714-9613
Phone (417) 724-5450

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement37
Knee replacement55

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
87351GAMDEmergency Medicine Physician
52399SCMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Sep 1, 2023 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Sep 1, 2023 Accepting new patients
Orthopaedic Clinical Assoc Inc. CurrentSince Aug 1, 2022 Accepting new patients
Optim Orthopedics, LLC Orthopaedic Surgery CurrentSince Jul 28, 2018 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Sep 1, 2023 Accepting new patients
Mayo Clinic Health System in Waycross, Inc. Past Accepting new patients
Optim Orthopedics, LLC Orthopaedic Surgery PastSince Oct 6, 2019 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

810 Towne Park Dr
Ste 200
Rincon, GA 31326
Phone (912) 826-2533

210 E Derenne Ave
Savannah, GA 31405
Phone (912) 355-0140

91 Parker Hill Ave
Roxbury Xing, MA 02120
Phone (617) 754-6742

940 W Mount Vernon St
Ste 110
Nixa, MO 65714
Phone (417) 724-5220

3050 E River Bluff Blvd
Ozark, MO 65721
Phone (417) 820-5610

3050 E River Bluff Blvd
Ste 2ND
Ozark, MO 65721

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Interoperability endpoints

  • Direct secure messaging: andrew.jackson.1@11118.direct.athenahealth.com
  • Direct secure messaging: andrew.jackson.1@16403.direct.athenahealth.com

Organizations & group practices 8

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1362268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792022400000",
    "number": "1093056988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E DERENNE AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056736",
            "telephone_number": "912-644-5300",
            "fax_number": "912-644-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 E RIVER BLUFF BLVD",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657218807",
            "telephone_number": "417-820-5610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "166 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Jesup",
            "state": "GA",
            "postal_code": "315450101",
            "country_code": "US",
            "telephone_number": "912-427-0800",
            "fax_number": "912-427-6029",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1061 Harmon Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Stewart",
            "state": "GA",
            "postal_code": "313145641",
            "country_code": "US",
            "telephone_number": "912-435-6965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "602 E Long St",
            "address_purpose": "LOCATION",
            "city": "Claxton",
            "state": "GA",
            "postal_code": "304175914",
            "country_code": "US",
            "telephone_number": "912-739-3275",
            "fax_number": "912-439-4011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8 N Williams St",
            "address_purpose": "LOCATION",
            "city": "Metter",
            "state": "GA",
            "postal_code": "304394547",
            "country_code": "US",
            "telephone_number": "912-685-3550",
            "fax_number": "912-685-3553",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "810 Towne Park Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Rincon",
            "state": "GA",
            "postal_code": "313265167",
            "country_code": "US",
            "telephone_number": "912-826-2533",
            "fax_number": "912-826-2572",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 W Mulberry Blvd, Ste 140",
            "address_purpose": "LOCATION",
            "city": "Pooler",
            "state": "GA",
            "postal_code": "31322",
            "country_code": "US",
            "telephone_number": "912-748-5111",
            "fax_number": "912-748-6699",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16915 Highway 67 Ste A",
            "address_purpose": "LOCATION",
            "city": "Statesboro",
            "state": "GA",
            "postal_code": "304585819",
            "country_code": "US",
            "telephone_number": "912-681-2500",
            "fax_number": "912-681-2025",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "60 Exchange St Ste B1",
            "address_purpose": "LOCATION",
            "city": "Richmond Hill",
            "state": "GA",
            "postal_code": "313247646",
            "country_code": "US",
            "telephone_number": "912-756-2273",
            "fax_number": "912-756-3773",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "210 E DeRenne Ave",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314056736",
            "country_code": "US",
            "telephone_number": "912-644-5300",
            "fax_number": "912-644-5241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANDREW",
        "middle_name": "THOMAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-03",
        "last_updated": "2026-10-15",
        "certification_date": "2026-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "081265",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "SC",
            "license": "52399",
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "MO",
            "license": "2023005796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "523990",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003209886A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ozark, MO

Sources for this page

Verify at the official NPI Registry.