Richard Wayne Jackson, M.D.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

01028135 Issued in IN

Practice address

6920 Gatwick Dr
Ste 200
Indianapolis, IN 46241-9504

Phone

(317) 455-1064

Fax

(317) 455-1204

NPI assigned

Jun 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 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)
• University Orthopaedic Associates, Inc.

  • Orthopaedic Surgery Physician
  • Indianapolis, IN
  • NPI 1841241437
  NPD (past)

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457568000000",
    "number": "1245236769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 GATWICK DR",
            "address_2": "STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462419504",
            "telephone_number": "317-455-1064",
            "fax_number": "317-455-1204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6920 GATWICK DR",
            "address_2": "STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462419504",
            "telephone_number": "317-455-1064",
            "fax_number": "317-455-1204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RICHARD",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2016-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IN",
            "license": "01028135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan Lowell Jackson, DPM
• Nicholas Jackson
• Nikki Jackson
• Olivia Jackson
• Renisha Jackson, RBT
• Samantha Ann Jackson, N.P.
• Steffen Jackson
• Stephanie J. Jackson, M.D.
• Tangenee N Jackson
• Tatiana Jackson, RBT

• Orthopaedic Surgery Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Orthopaedic Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; 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.