Kathy Jo Jackson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

070748 Issued in MI

Practice address

117 W Paterson St
Kalamazoo, MI 49007-2557

Phone

(269) 349-2641

Fax

(269) 349-2898

NPI assigned

Dec 1, 2006

Last updated

Dec 27, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Kalamazoo, MI
  • NPI 1811065576
  Medicare reassignment NPD
• Family Health Center Inc

  dba Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Kalamazoo, MI
  • NPI 1215768296
  NPD

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672099200000",
    "number": "1306914296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 PINEHURST BLVD",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490062110",
            "telephone_number": "269-349-2641",
            "fax_number": "269-349-2898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 W PATERSON ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490072557",
            "telephone_number": "269-349-2641",
            "fax_number": "269-349-2898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 E Alcott St",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490016144",
            "country_code": "US",
            "telephone_number": "269-349-2641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KATHY",
        "middle_name": "JO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "070748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104509048",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amari Jackson
• Angela Jackson
• Carmony Lateece Jackson
• Cinnamon Jackson
• De Lorenco L Jackson
• Kayla Jackson
• Larry Jackson, M.D.
• Lluvia Ivonne Jackson, LLMSW
• Matthew Jackson, LMSW
• Peyton Jackson

• Pediatrics Physician in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.