Samantha Jackson MD PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

19876 Issued in OK

Legal business name

SAMANTHA JACKSON MD PLLC

Practice address

415 W Forest LN
Hobart, OK 73651-1645

Phone

(580) 726-2226

Fax

(580) 726-8425

NPI assigned

Jul 1, 2013

Organization subpart

Yes

Parent organization

SAMANTHA L JACKSON MDAs reported in NPPES

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

Authorized official

Name

Samantha L Jackson, M.D.NPI 1104806967

Title

Owner

Phone

(580) 726-2226

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Samantha Jackson MD PLLC

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CBHJCD

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samantha Jackson, MD

  • Family Medicine Physician
  • Hobart, OK
  • NPI 1104806967
  Medicare reassignment NPD Authorized official
• Sheila Marie Coffman, PA

  • Medical Physician Assistant
  • Elk City, OK
  • NPI 1366605446
  NPD (past)

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

{
    "created_epoch": "1372636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484524800000",
    "number": "1275973646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 W FOREST LN",
            "city": "HOBART",
            "state": "OK",
            "postal_code": "736511645",
            "telephone_number": "580-726-2226",
            "fax_number": "580-726-8425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W FOREST LN",
            "city": "HOBART",
            "state": "OK",
            "postal_code": "736511645",
            "telephone_number": "580-726-2226",
            "fax_number": "580-726-8425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMANTHA JACKSON MD PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAMANTHA L JACKSON MD",
        "enumeration_date": "2013-07-01",
        "last_updated": "2017-01-16",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-726-2226",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "19876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200491840A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Dalton Reed, B.S.
• Paul D Reed, D.C.
• Preston Douglas Reed, D.C.
• Regional Radiology Inc
• Patricia S Rouse
• Susan Gayle Sanchez, ASSOCIATES DEGREE
• Julie A Schaufele, MD
• Searchlight Center Inc
• Searchlight Center, Inc.
• William Louis Sims, MD

• Family Medicine Physician in Hobart, OK
• Providers in Hobart, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2017; 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.