NPIMap

Organization Active NPI

Jackson Hospital & Clinic, Inc.

Doing business as Jackson Clinic Gastro Ste 406

  • Gastroenterology Physician
  • Montgomery, AL
National Provider Identifier
1316447063
Registry record updated Mar 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
JACKSON HOSPITAL & CLINIC, INC.
Doing business as
Jackson Clinic Gastro Ste 406
Practice address
1722 Pine St Ste 406
Montgomery, AL 36106-1159
Phone
(334) 293-6825
Fax
(334) 293-6826
NPI assigned
Feb 20, 2018
Last updated
Mar 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2026

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

Authorized official

Name
Kelin Penney
Title
Executive Director
Phone
(334) 240-2335

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X Primary

Addresses

Primary practice location

1722 Pine St Ste 406
Montgomery, AL 36106-1159

Mailing address

1722 Pine St Ste 804
Montgomery, AL 36106-1108
Phone (334) 293-8736

Other names 1

  • Jackson Clinic Gastro Ste 406 Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address JACKSONCLINICENROLLMENT@JACKSON.ORG Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040414000971 AL Part B Supplier - Clinic/Group Practice 0547254153 Receives reassigned benefits from 247 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Aeras71 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

321 Greenville Byp
Ste 2
Greenville, AL 36037

Interoperability endpoints

  • Direct secure messaging: jacksonclinicenrollment@jackson.org

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1519084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773014400000",
    "number": "1316447063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 PINE ST STE 804",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061108",
            "telephone_number": "334-293-8736",
            "fax_number": "334-293-8738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1722 PINE ST STE 406",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061159",
            "telephone_number": "334-293-6825",
            "fax_number": "334-293-6826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOSPITAL & CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-20",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A",
        "authorized_official_last_name": "PENNEY",
        "authorized_official_first_name": "KELIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "334-240-2335"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JACKSONCLINICENROLLMENT@JACKSON.ORG",
            "affiliation": "N",
            "endpointDescription": "EMAIL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1722 Pine St Ste 804",
            "city": "Montgomery",
            "state": "AL",
            "country_code": "US",
            "postal_code": "361061108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Jackson Clinic Gastro Ste 406",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.