Grant Wells Jackson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD60002207 Issued in WA

Practice address

319 E Pioneer Ave
Grant W Jackson MD PS
Montesano, WA 98563-4601

Phone

(360) 249-1980

Fax

(360) 249-1993

NPI assigned

Dec 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Washington Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Washington, PA
  • NPI 1639133861
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217808000000",
    "number": "1306901475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 E PIONEER AVE",
            "address_2": "GRANT W JACKSON MD PS",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985634601",
            "telephone_number": "360-249-1980",
            "fax_number": "360-249-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 E PIONEER AVE",
            "address_2": "GRANT W JACKSON MD PS",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985634601",
            "telephone_number": "360-249-1980",
            "fax_number": "360-249-1993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "GRANT",
        "middle_name": "WELLS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2008-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "ML002797",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "ML002797",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60002207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Hanson
• Don Hoefert Jr., PTA
• Hometown Family Health
• Kendra Danielle Hyde, 60978136OTA.OC
• Brittany Ann Jackson, PT, DPT
• Stephanie Janssen, LMHCA
• Brooke Mercedes Joaquin
• Mikaila Ann Johnson, OTR
• Sara Eileen Johnson
• Bessie Jones

• Family Medicine Physician in Montesano, WA
• Providers in Montesano, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; 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.