Jon C Jackson, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME28054 Issued in FL

Practice address

4770 S Ridgewood Ave
Port Orange, FL 32127-4544

Phone

(386) 761-0050

Fax

(386) 761-1167

NPI assigned

Aug 5, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Metcare of Florida, Inc

  dba Conviva Care Center

  • Internal Medicine Physician
  • Port Orange, FL
  • NPI 1619433869
  NPD (past)

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1093724551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4770 S RIDGEWOOD AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274544",
            "telephone_number": "386-761-0050",
            "fax_number": "386-761-1167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4770 S RIDGEWOOD AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274544",
            "telephone_number": "386-761-0050",
            "fax_number": "386-761-1167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JON",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME28054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "64353",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "013",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Michel Iskandar
• Isner Chiropractic Clinic, Inc.
• J. Kim Periodontics, LLC
• J. Michael Panczyszyn, D.D.S., PA
• Denise Jacks, ARNP
• Serenity Leilani Jackson, OTR
• Deric L Jacobs, DC
• Jessica Jacobsen
• Abbie Conrad James, LMHC
• Karen James

• Specialist in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.