Richard J Jackson, MD

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

N3094 Issued in TX

Practice address

1901 SW H K Dodgen Loop
Temple, TX 76502-3500

Phone

(254) 935-4000

Fax

(254) 935-4111

NPI assigned

Oct 13, 2006

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 5

Medicare fee-for-service enrollment

Enrolled in AR, WV2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et1036.epichosted.com/APIProxyPRD/AC/api/FHIR/R4
• Direct secure messaging: rjackson561044@direct.sw.org

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.

• Arkansas Childrens Hospital

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1598773079
  Medicare reassignment NPD
• University of Arkansas for Medical Sciences

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1346230968

  Pediatric Surgery

  Medicare reassignment NPD
• Arkansas Children'S Hospital

  • Children's Hospital
  • Little Rock, AR
  • NPI 1477561983
  NPD
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD
• University of Arkansas for Medical Sciences

  • Psychologist
  • Little Rock, AR
  • NPI 1114255353
  NPD
• Arkansas Childrens Hospital

  • Children's Hospital
  • Little Rock, AR
  • NPI 1194776757
  NPD (past)
• Arkansas Childrens Hospital

  • Dental Clinic/Center
  • Little Rock, AR
  • NPI 1770889552
  NPD (past)
• Arkansas Childrens Northwest, Inc.

  • Children's Hospital
  • Springdale, AR
  • NPI 1255875746
  NPD (past)

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1215027883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 SW H K DODGEN LOOP",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765023500",
            "telephone_number": "254-935-4000",
            "fax_number": "254-935-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RICHARD",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "AR",
            "license": "N-8271",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "TX",
            "license": "N3094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125912907",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137345810",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140442852",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121627001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125912908",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy R. Jackson, RD
• Brandi Faye Jackson, CPNP-AC
• Denise Jackson, LCSW,ACSW,LCDC,BCD,
• Kali Jackson
• Morgan Thomas Jackson, M.A.
• Tiffany R Jackson, LVN
• Allen Zacharia Jacob, MD
• Lorena Jacobo, LMSW
• Emily Anne Jacobs
• Justin David Jacobs

• Pediatric Surgery Physician in Temple, TX
• Providers in Temple, TX by specialty
• Pediatric Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.