NPIMap

Individual provider Active NPI

Michael S Jackson, MD

  • Obstetrics & Gynecology Physician
  • Enid, OK
National Provider Identifier
1194755793
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
30290 Issued in OK
Practice address
620 S Madison St Ste 304
Enid, OK 73701-7270
Phone
(580) 233-6350
Fax
(580) 233-6106
NPI assigned
Jul 3, 2006
Last updated
Sep 9, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 04-28958 KS
Obstetrics & Gynecology Physician 207V00000X 30290 OK Primary

Addresses

Primary practice location

620 S Madison St Ste 304
Enid, OK 73701-7270

Mailing address

5300 N Independence Ave
280
Oklahoma City, OK 73112-5556
Phone (580) 233-6350

Other identifiers 2

IdentifierTypeStateIssuer
100387680AMedicaidKS
100387680HMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140219001563 OK Practitioner - Obstetrics/Gynecology 2365339140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Nebraska College of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

620 S Madison St
Suite 301
Enid, OK 73701-7270
Phone (580) 977-1903

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Ambulatory Care Corporation Obstetrics & Gynecology CurrentSince Nov 30, 2013 Accepting new patients
Integris Bass Baptist Health Center Past Accepting new patients
Integris Bass Baptist Health Center PastSince May 1, 2019 Accepting new patients
Via Christi Regional Medical Center Inc Obstetrics & Gynecology Past Accepting new patients
Ascension Via Christi Hospitals Wichita Inc. Past Accepting new patients
Ascension Via Christi Hospitals Wichita Inc. Past Accepting new patients
Via Christi Regional Medical Center Past Accepting new patients
Integris Rural Health Inc Past Accepting new patients

Locations

620 S Madison St
Ste 301
Enid, OK 73701
Phone (580) 233-6350

620 S Madison St
Ste 304
Enid, OK 73701
Phone (580) 242-1300

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

5300 N Independence Ave
Ste 280
Oklahoma City, OK 73112
Phone (405) 552-0155

Interoperability endpoints

  • Direct secure messaging: mjackson8621@direct.integrisok.com

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Integris Health Enid HospitalEnid, OK, CCN 370016 Hospital Corporate Officer May 1, 2019
Integris Home Care EnidEnid, OK, CCN 377208 Home health agency Corporate Officer May 1, 2019
Integris Health Medical Group MedfordMedford, OK, CCN 373873 Rural health clinic Corporate Officer May 1, 2019
Integris Health Medical Group WaynokaWaynoka, OK, CCN 373872 Rural health clinic Corporate Officer May 1, 2019

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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.

Hospital & facility affiliations 3

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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1194755793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 N INDEPENDENCE AVE",
            "address_2": "280",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125556",
            "telephone_number": "580-233-6350",
            "fax_number": "580-233-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 S MADISON ST STE 304",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737017270",
            "telephone_number": "580-233-6350",
            "fax_number": "580-233-6106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "KS",
            "license": "04-28958",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OK",
            "license": "30290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100387680A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100387680H",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enid, OK

Sources for this page

Verify at the official NPI Registry.