Edward Leslie Jackson, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

E-4775 Issued in AR

Practice address

3344 N Futrall Dr
Fayetteville, AR 72703-4057

Phone

(479) 521-8200

Fax

(479) 582-7310

NPI assigned

Nov 21, 2005

Sex

Male

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 4

Electronic endpoints 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

Pulmonary DiseaseAlso: Critical Care (Intensivists)

Education

University of Arkansas College of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Medical Associates of Northwest Arkansas, PAGroup PAC ID 3678542073, 102 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Washington Regional Medical Center Hospital, Fayetteville, AR, CCN 040004
• Mercy Hospital Fort Smith Hospital, Fort Smith, AR, CCN 040062

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.

• Medical Associates of Northwest Arkansas, PA

  • Internal Medicine Physician
  • Fayetteville, AR
  • NPI 1801847827

  Pulmonary Disease

  Medicare reassignment Care Compare group NPD
• Medical Associates of Northwest Arkansas PA

  • Diagnostic Radiology Physician
  • Fayetteville, AR
  • NPI 1134170160
  NPD
• Medical Associates of Northwest Arkansas PA

  • Family Medicine Physician
  • Lowell, AR
  • NPI 1912883273
  NPD
• Medical Associates of Northwest Arkansas PA

  • Podiatrist
  • Fayetteville, AR
  • NPI 1164140729
  NPD (past)
• Medical Associates of Northwest Arkansas PA

  • Family Medicine Physician
  • Fayetteville, AR
  • NPI 1710218995

  Pulmonary Disease

  NPD (past)
• Medical Associates of Northwest Arkansas PA

  • Family Medicine Physician
  • Springdale, AR
  • NPI 1831149582
  NPD (past)

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

• Mercy Hospital Fort Smith

  • General Acute Care Hospital
  • Fort Smith, AR
  • NPI 1568433480
  Care Compare affiliation
• Washington Regional Medical Center

  • General Acute Care Hospital
  • Fayetteville, AR
  • NPI 1083609150
  Care Compare affiliation

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1174506448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1523",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727021523",
            "telephone_number": "479-521-8200",
            "fax_number": "479-582-7310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3344 N FUTRALL DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034057",
            "telephone_number": "479-521-8200",
            "fax_number": "479-582-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EDWARD",
        "middle_name": "LESLIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "AR",
            "license": "E-4775",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "AR",
            "license": "E-4775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BCBS",
            "identifier": "5N545",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "P00327943",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160768001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200088310A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "edward.jackson@mana.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "edward.jackson@mana.eclinicaldirectplus.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3344 N Futrall Dr",
            "city": "Fayetteville",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727034057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tara J Jackson-Farmer
• Amber Adney Jackson, LCSW
• Carol Jackson, LISW - S, LICDC
• Charles David Jackson, MD
• Charles Mark Jackson, M.D.
• Holly Jackson, DPT
• Kaitlin Jackson, MHPP
• Laura Lynn Jackson, PA-C
• Scott M Jackson, M.D.
• Tammie Jackson

• Pulmonary Disease Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Pulmonary Disease Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; 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.