NPIMap

Individual provider Active NPI

Thomas Cozatt Jackson Jr., MD

  • Family Medicine Physician
  • Harrodsburg, KY
National Provider Identifier
1306818968
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
29222 Issued in KY
Practice address
470 Linden Ave
Harrodsburg, KY 40330-1871
Phone
(859) 734-4307
Fax
(859) 734-4300
NPI assigned
Feb 7, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 29222 KY Primary

Addresses

Primary practice location

470 Linden Ave
Harrodsburg, KY 40330-1871

Mailing address

470 Linden Ave Ste 3-4
Harrodsburg, KY 40330-1871
Phone (859) 734-4307

Other identifiers 1

IdentifierTypeStateIssuer
64292220MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100916001262 KY Practitioner - Family Practice 5496718629 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisville Medical College, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

470 Linden Ave
Suite 3And4
Harrodsburg, KY 40330-1871
Phone (859) 734-4307

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
LP Harrodsburg, LLC Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The James B Haggin Memorial Hospital IncHarrodsburg, KY, CCN 181302 Hospital Corporate Director Jan 1, 2019
The James B Haggin Memorial Hospital IncHarrodsburg, KY, CCN 18Z302 Hospital Corporate Director Jan 1, 2019
Ephraim McDowell Mercer PediatricsHarrodsburg, KY, CCN 188517 Rural health clinic Corporate Director Dec 1, 2017

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306818968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 LINDEN AVE STE 3-4",
            "city": "HARRODSBURG",
            "state": "KY",
            "postal_code": "403301871",
            "telephone_number": "859-734-4307",
            "fax_number": "859-734-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 LINDEN AVE",
            "city": "HARRODSBURG",
            "state": "KY",
            "postal_code": "403301871",
            "telephone_number": "859-734-4307",
            "fax_number": "859-734-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "THOMAS",
        "middle_name": "COZATT",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "29222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64292220",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrodsburg, KY

Sources for this page

Verify at the official NPI Registry.