NPIMap

Individual provider Active NPI

Grant Wells Jackson, MD

  • Family Medicine Physician
  • Montesano, WA
National Provider Identifier
1306901475
Registry record updated Aug 4, 2008
On this page

Key facts

NPPES NPI Registry
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
Last updated
Aug 4, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2008

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X ML002797 PA
Family Medicine Physician 207Q00000X ML002797 PA
Family Medicine Physician 207Q00000X MD60002207 WA Primary

Addresses

Primary practice location

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

Mailing address

319 E Pioneer Ave
Grant W Jackson MD PS
Montesano, WA 98563-4601
Phone (360) 249-1980

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

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Hospital Emergency Medicine Past Accepting new patients

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.

NPI Registry JSON

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": []
}

Other providers in Montesano, WA

Sources for this page

  • 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.