Jackson Podiatry, Inc

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

36003456 Issued in OH

Legal business name

JACKSON PODIATRY, INC

Practice address

1201 Belmont Ave
Youngstown, OH 44504

Phone

(330) 333-3365

NPI assigned

Jun 16, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Derrick O Jackson, DPM

Title

Podiatrist

Phone

(330) 398-3777

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1181952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545955200000",
    "number": "1306041744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 BELMONT AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445041101",
            "telephone_number": "330-333-3365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 BELMONT AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "44504",
            "telephone_number": "330-333-3365"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 Belmont Ave",
            "address_purpose": "LOCATION",
            "city": "Youngstown",
            "state": "OH",
            "postal_code": "44504",
            "country_code": "US",
            "telephone_number": "330-333-3365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JACKSON PODIATRY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-16",
        "last_updated": "2018-12-28",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "330-398-3777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "OH",
            "license": "36003456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2736098",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Garame Ivey
• J1S Freight & Transportation LLC
• J1S Freight & Transportation LLC
• J2L Logistics LLC
• Jackie Ezell
• Brandon Jackson
• Breyon Jackson
• Brittany P Jackson, RN
• Caseem L Jackson
• Cazhia Jackson

• Foot Surgery Podiatrist in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Foot Surgery Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.