Active NPI
Fredric Neven Jackson, MD PS
- Internal Medicine Physician
- Burien, WA
National Provider Identifier
1285627547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD00019031
- Practice address
- 16259 Sylvester Rd SW
Ste 404
Burien, WA 98166-3049 - Phone
- (206) 241-1818
- Fax
- (206) 244-3991
- NPI assigned
- Aug 23, 2005
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD00019031 | WA | Primary |
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | MD00019031 | WA | |
| Pulmonary Disease Physician | 207RP1001X | MD00019031 | WA |
Addresses
Primary practice location
16259 Sylvester Rd SW
Ste 404
Burien, WA 98166-3049
Mailing address
16259 Sylvester Rd SW Ste 404
Burien, WA 98166-3059
Phone (206) 241-1818
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110046684 | Other | WA | RR MEDICARE |
| 1783901 | Medicaid | WA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00019031 | WA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399852800000",
"number": "1285627547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16259 SYLVESTER RD SW STE 404",
"city": "BURIEN",
"state": "WA",
"postal_code": "981663059",
"telephone_number": "206-241-1818",
"fax_number": "206-244-3991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16259 SYLVESTER RD SW",
"address_2": "STE 404",
"city": "BURIEN",
"state": "WA",
"postal_code": "981663049",
"telephone_number": "206-241-1818",
"fax_number": "206-244-3991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "FREDRIC",
"middle_name": "NEVEN",
"credential": "MD PS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-23",
"last_updated": "2014-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WA",
"license": "MD00019031",
"primary": true
},
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "WA",
"license": "MD00019031",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "WA",
"license": "MD00019031",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "110046684",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1783901",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burien, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.