Thomas L Jackson, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

01046379A Issued in IN

Practice address

2450 N Park Dr
Columbus, IN 47203-2216

Phone

(812) 376-8997

Fax

(812) 373-5323

NPI assigned

Dec 22, 2005

Last updated

Aug 2, 2010By 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

Enrolled in IN

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

Plastic and Reconstructive SurgeryAlso: General Practice

Education

Indiana University School of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Indiana Aesthetic and Plastic Surgery LLCGroup PAC ID 3870752462, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Columbus Regional Hospital Hospital, Columbus, IN, CCN 150112
• Schneck Medical Center Hospital, Seymour, IN, CCN 150065
• Community Hospital East Hospital, Indianapolis, IN, CCN 150074

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: tjackson@directglo.com

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.

• Southern Indiana Aesthetic and Plastic Surgery LLC

  • Surgical Technologist
  • Columbus, IN
  • NPI 1487765103
  Medicare reassignment Care Compare group Authorized official
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

• Columbus Regional Hospital

  • General Acute Care Hospital
  • Columbus, IN
  • NPI 1104998624
  Care Compare affiliation
• Community Health Network, Inc

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1336119478
  Care Compare affiliation
• Jackson County Schneck Memorial Hospital

  dba Schneck Medical Center

  • General Acute Care Hospital
  • Seymour, IN
  • NPI 1699738088
  Care Compare affiliation

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280707200000",
    "number": "1154308997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 N PARK DR",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472032292",
            "telephone_number": "812-376-8997",
            "fax_number": "812-373-5323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 N PARK DR",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472032216",
            "telephone_number": "812-376-8997",
            "fax_number": "812-373-5323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "THOMAS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2010-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IN",
            "license": "01046379A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "01046379A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200134430B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dessie Jackson
• Judith Amy Jackson, FNP-C
• Leah Jackson
• Lori A Jackson, NP
• Madison Keelie Jackson
• Monish Jain, MD
• Amber Rose James, NP
• Ann Elizabeth James, NURSE PRACTITIONER
• Emma James, RBT
• Lauryn James, LMHC-A

• Specialist in Columbus, IN
• Providers in Columbus, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.