Active NPI
Howard Franklin Jackson, DPM
- Foot Surgery Podiatrist
- East Saint Louis, IL
National Provider Identifier
1255453718
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Aug 20, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Foot Surgery Podiatrist
- License
- 016003650
- Practice address
- 4601 State St
Suite 310
East Saint Louis, IL 62205-1359 - Phone
- (618) 875-7230
- Fax
- (618) 875-7230
- NPI assigned
- Apr 4, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot Surgery Podiatrist | 213ES0131X | 016003650 | IL | Primary |
Addresses
Primary practice location
4601 State St
Suite 310
East Saint Louis, IL 62205-1359
Mailing address
4601 State St
Suite 310
East Saint Louis, IL 62205-1359
Phone (618) 875-7230
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 016003650 | Medicaid | IL | |
| 2780264 | Other | IL | UNITED HEALTHCARE |
| 0060101272 | Other | IL | BLUE SHEILD |
| 480004788 | Other | IL | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016003650 | IL | MD | Foot Surgery Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255453718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 STATE ST",
"address_2": "SUITE 310",
"city": "EAST SAINT LOUIS",
"state": "IL",
"postal_code": "622051359",
"telephone_number": "618-875-7230",
"fax_number": "618-875-7230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4601 STATE ST",
"address_2": "SUITE 310",
"city": "EAST SAINT LOUIS",
"state": "IL",
"postal_code": "622051359",
"telephone_number": "618-875-7230",
"fax_number": "618-875-7230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "HOWARD",
"middle_name": "FRANKLIN",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0131X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot Surgery",
"state": "IL",
"license": "016003650",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "016003650",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2780264",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHEILD",
"identifier": "0060101272",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "480004788",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Saint Louis, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.