NPIMap

Organization Active NPI

Jackson Hospital & Clinic, Inc.

Doing business as Jackson Family Medicine Midtown

  • Family Medicine Physician
  • Montgomery, AL
National Provider Identifier
1245750660
Registry record updated Apr 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JACKSON HOSPITAL & CLINIC, INC.
Doing business as
Jackson Family Medicine Midtown
Practice address
4150 Carmichael Rd Ste B
Montgomery, AL 36106-2933
Phone
(334) 293-8282
Fax
(334) 293-8286
NPI assigned
Jun 27, 2017
Last updated
Apr 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2020

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

Authorized official

Name
Tara Herring
Title
Revenue Cycle Director
Phone
(334) 240-2337

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4150 Carmichael Rd Ste B
Montgomery, AL 36106-2933

Mailing address

1722 Pine St Ste 503
Montgomery, AL 36106-1160
Phone (334) 293-8736

Other names 1

  • Jackson Family Medicine Midtown Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040414000971 AL Part B Supplier - Clinic/Group Practice 0547254153 Receives reassigned benefits from 247 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Aeras71 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586217600000",
    "number": "1245750660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 PINE ST STE 503",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061160",
            "telephone_number": "334-293-8736",
            "fax_number": "334-293-8738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 CARMICHAEL RD STE B",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361062933",
            "telephone_number": "334-293-8282",
            "fax_number": "334-293-8286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOSPITAL & CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-27",
        "last_updated": "2020-04-07",
        "certification_date": "2020-04-07",
        "status": "A",
        "authorized_official_last_name": "HERRING",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "334-240-2337"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Family Medicine Midtown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.