NPIMap

Individual provider Active NPI

Mark Maurice Jackson, DO

  • Emergency Medicine Physician
  • Gainesville, FL
National Provider Identifier
1144391525
Registry record updated Aug 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OS10806 Issued in FL
Practice address
1600 SW Archer Rd
Gainesville, FL 32610-3003
Phone
(352) 265-5911
Fax
(352) 265-5606
NPI assigned
Nov 10, 2006
Last updated
Aug 10, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OS10806 FL Primary
Emergency Medicine Physician 207P00000X DOS1302 HI

Addresses

Primary practice location

1600 SW Archer Rd
Gainesville, FL 32610-3003

Mailing address

PO Box 918025
Orlando, FL 32891-0001
Phone (352) 265-5911

Other identifiers 1

IdentifierTypeStateIssuer
001554600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, TX2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20100112000766 FL Practitioner - Emergency Medicine 0749321776 Reassigns benefits to 1 organization
I20161019001850 TX Practitioner - Emergency Medicine 0749321776 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lawton Indian HospitalGroup PAC ID 6406800234, 126 clinicians

Practice addresses (Care Compare)

1515 NE Lawrie Tatum Rd
Lawton, OK 73507-3002
Phone (580) 354-5000

1600 SW Archer Rd
Gainesville, FL 32610-3003
Phone (352) 265-0111

US Hwy 160 S
MP 394
Kayenta, AZ 86033-0368
Phone (928) 697-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
47.54 of 100Reported as apm
Quality
38.49
Promoting interoperability
0
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
80.86 of 100Reported as group
Quality
61.32
Improvement activities
40
Cost
90.46

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS10806FLMDEmergency Medicine Physician
DOS1302HIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Mar 4, 2017 Accepting new patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility CurrentSince Apr 2, 2024 Accepting new patients
Choctaw Nation of Oklahoma CurrentSince Sep 6, 2016 Accepting new patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility Current Accepting new patients
Tuba City Regional Health Care Corporation Emergency Medicine CurrentSince Dec 18, 2016 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Mar 4, 2017 Accepting new patients
Choctaw Nation of Oklahoma CurrentSince Sep 6, 2016 Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Dec 18, 2016 Accepting new patients
Lawton Indian Hospital CurrentSince Mar 15, 2023 Accepting new patients
DHHS PHS Naihs Chinle Comprehensive CurrentSince Apr 2, 2024 Accepting new patients
City Circle ER SVCS Partnership LLC Emergency Medicine Past Accepting new patients
Floridian Emergency Specialists, LLC Emergency Medicine PastSince Jan 26, 2020 Accepting new patients

Locations

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1515 NE Lawrie Tatum Rd
Lawton, OK 73507
Phone (580) 353-0350

1 Choctaw Way
Talihina, OK 74571
Phone (918) 423-8440

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: mjackson14158@direct.shands.ufl.edu

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312934400000",
    "number": "1144391525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 918025",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328910001",
            "telephone_number": "352-265-5911",
            "fax_number": "352-265-5606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326103003",
            "telephone_number": "352-265-5911",
            "fax_number": "352-265-5606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARK",
        "middle_name": "MAURICE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-10",
        "last_updated": "2011-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS10806",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "HI",
            "license": "DOS1302",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001554600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.