Anthony Wade Jackson Sr., M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

14917 Issued in MS

Practice address

152 Highway 7 S
Oxford, MS 38655-5392

Phone

(662) 488-8878

NPI assigned

Jan 27, 2007

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

Medicare fee-for-service enrollment

Enrolled in TN, MS2 enrollments

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 2

Specialty

Psychiatry

Education

Meharry Medical College School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Mississippi Commission on Mental Illness/Mental Retardation 22 clinicians

Vogelfanger and Struble Clinic 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• North Mississippi Commission on Mental Illness/Mental Retardation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Oxford, MS
  • NPI 1558468694

  MS

  Medicare reassignment Care Compare group
• Vogelfanger and Struble Clinic

  • Psychiatry Physician
  • Memphis, TN
  • NPI 1508895764

  TN

  Medicare reassignment Care Compare group
• Yalobusha General Hospital

  • General Acute Care Hospital
  • Water Valley, MS
  • NPI 1740380914

  MS

  Medicare reassignment NPD
• Yalobusha General Hospital

  • Nurse Practitioner
  • Water Valley, MS
  • NPI 1386024438
  NPD
• Alliance Health Partners, LLC

  • Rural Health Clinic/Center
  • Batesville, MS
  • NPI 1922331867
  NPD (past)
• Garden Park

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Greenwood, MS
  • NPI 1932437209
  NPD (past)
• Rehabilitation Centers, LLC

  • Psychiatric Residential Treatment Facility
  • Pontotoc, MS
  • NPI 1255448775
  NPD (past)
• Tri Lakes Medical Center

  • Special Hospital
  • Batesville, MS
  • NPI 1366533093
  NPD (past)
• Keystone Memphis, LLC

  • Psychiatric Hospital
  • Memphis, TN
  • NPI 1063431294
  NPD (past)

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

{
    "created_epoch": "1169856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441756800000",
    "number": "1154477453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 HIGHWAY 7 S",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555392",
            "telephone_number": "662-488-8878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 HIGHWAY 7 S",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555392",
            "telephone_number": "662-488-8878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANTHONY",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-27",
        "last_updated": "2015-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MS",
            "license": "14917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Internal Medicine Associates of Oxford
• Sheel Iqbal, MD
• Hannah Ivey
• Juanita Ivy, PMHNP
• J. a. Riffe OD PC
• Lawanda Jackson, BSW, BSW
• Tequilla Marie Jackson, BA
• Barbara Alessandra Jacobs, MD
• Kimberly Michelle Jacobs, LPC
• Ahmad Jalil, MD

• All providers in Oxford, MS
• Child & Adolescent Psychiatry Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2015; 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.