Audra M Jackson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E6098 Issued in AR

Practice address

3808 South Gary
Fort Smith, AR 72903-5450

Phone

(479) 709-7120

Fax

(479) 709-7123

NPI assigned

Sep 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Family Practice

Education

University of Virginia School of Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baptist Health ServicesGroup PAC ID 0648514133, 103 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kindred at Home 1 Home health agency, Fort Smith, AR, CCN 047038
• Elite Home Health Home health agency, Fort Smith, AR, CCN 047339
• Baptist Health - Fort Smith Hospital, Fort Smith, AR, CCN 040055

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ajackson219700@direct.baptist-healthar.org

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.

• Baptist Health Services

  dba Baptist Health Foot and Ankle Clinic-Fort Smith

  • Foot & Ankle Surgery Podiatrist
  • Fort Smith, AR
  • NPI 1922587690
  Medicare reassignment Care Compare group NPD
• Baptist Health Services

  • Family Medicine Physician
  • Fort Smith, AR
  • NPI 1750856043
  NPD

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

• Baptist Health Regional Hospitals

  dba Baptist Health - Fort Smith

  • General Acute Care Hospital
  • Fort Smith, AR
  • NPI 1710463146
  Care Compare affiliation
• Centerwell Certified Healthcare Corp.

  dba CenterWell Home Health

  • Home Health Agency
  • Fort Smith, AR
  • NPI 1619909884
  Care Compare affiliation
• LHCG Xlii, LLC

  dba Elite Home Health

  • Home Health Agency
  • Fort Smith, AR
  • NPI 1154668895
  Care Compare affiliation

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282521600000",
    "number": "1093815268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 402319",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303842319",
            "telephone_number": "479-709-7399",
            "fax_number": "479-709-7053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3808 SOUTH GARY",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035450",
            "telephone_number": "479-709-7120",
            "fax_number": "479-709-7123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AUDRA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2010-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E6098",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200231990A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J Brogan Lopez DDS PA
• J Michael Standefer MD PA
• J Steven Yaney
• J.B. Solomon, Inc. (Beltone)
• Andrea Jackson
• Carolyn Jackson
• Janissa D Jackson, PHD
• Jennifer Jackson, RDS, CIT
• McKenzie Alexandra Jackson, MD
• Michael Jackson, QBHP

• Family Medicine Physician in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2010; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.