Active NPI
Michael S Jackson, MD
- Family Medicine Physician
- Rome, GA
National Provider Identifier
1306830062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 055376
- Practice address
- 506 Riverside Pkwy NE
Ste 200
Rome, GA 30161-2902 - Phone
- (706) 266-2383
- NPI assigned
- Sep 8, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 055376 | GA | Primary |
Addresses
Primary practice location
506 Riverside Pkwy NE
Ste 200
Rome, GA 30161-2902
Mailing address
PO Box 40
Silver Creek, GA 30173-0040
Phone (706) 266-9090
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000807474D | Medicaid | GA | |
| 1164745782 | Other | MEDICARE TYPE 2 ORGANIZATIONAL NPI | |
| 202I080352 | Other | MEDICARE PTAN | |
| 000807474B | Medicaid | GA | |
| 000807474C | Medicaid | GA | |
| 1306830062 | Other | MEDICARE NPI |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565568000000",
"number": "1306830062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 40",
"city": "SILVER CREEK",
"state": "GA",
"postal_code": "301730040",
"telephone_number": "706-266-9090",
"fax_number": "706-204-8797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "506 RIVERSIDE PKWY NE",
"address_2": "STE 200",
"city": "ROME",
"state": "GA",
"postal_code": "301612902",
"telephone_number": "706-266-2383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHAEL",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-08",
"last_updated": "2019-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "055376",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000807474D",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE TYPE 2 ORGANIZATIONAL NPI",
"identifier": "1164745782",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "202I080352",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000807474B",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000807474C",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NPI",
"identifier": "1306830062",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Rome, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.