Brian Jackson

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056010871 Issued in IL

Practice address

1125 N Delany Rd
Gurnee, IL 60031-2007

Phone

(800) 974-4378

Fax

(630) 515-1536

NPI assigned

Jan 9, 2015

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 IL, WI2 enrollments

Enrollment records 2

Specialty

Occupational Therapist in Private Practice

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Illinois Bone and Joint Institute, LLCGroup PAC ID 6002814878, 603 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Illinois Bone and Joint Institute LLC

  • Orthopaedic Surgery Physician
  • Bannockburn, IL
  • NPI 1205922432
  Medicare reassignment Care Compare group NPD
• Midwest Orthopedic Specialty Hospital, LLC

  • Orthopaedic Surgery Physician
  • Franklin, WI
  • NPI 1275127375
  Medicare reassignment NPD
• Illinois Bone and Joint Institute, LLC

  • Orthopaedic Surgery Physician
  • Arlington Heights, IL
  • NPI 1962219568
  NPD
• Midwest Orthopedic Specialty Hospital, LLC

  • Orthopaedic Surgery Physician
  • Brookfield, WI
  • NPI 1750020897
  NPD
• Midwest Orthopedic Specialty Hospital, LLC

  • Durable Medical Equipment & Medical Supplies
  • Muskego, WI
  • NPI 1962238113
  NPD
• DPT Holdings PLLC

  • Occupational Therapist
  • Lemont, IL
  • NPI 1174149595
  NPD (past)
• DPT Holdings LLC

  • Occupational Therapist
  • Burlington, WI
  • NPI 1336752203
  NPD (past)

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

{
    "created_epoch": "1420761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1245629583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24014 W RENWICK RD STE F",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605448708",
            "telephone_number": "800-974-4378",
            "fax_number": "630-515-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 N DELANY RD",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312007",
            "telephone_number": "800-974-4378",
            "fax_number": "630-515-1536"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10320 75th St Ste D",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531427525",
            "country_code": "US",
            "telephone_number": "800-974-4378",
            "fax_number": "630-515-1536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-09",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056010871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ira J Piel MD Facp SC
• Mareen Itty, MOT
• Linda Ann Ivers, PT
• Henrietta Ann Ivy
• Tim M. Jackimek, D.D.S.
• Donna Marie Jackson, MSW, LSW, CDP
• Justin S Jacob, PHARMD
• Charles E Jaffe, DO
• Peter Eriq Jaffe
• Donville A James

• Occupational Therapist in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.