Active NPI
Jack D Jones Jr., MD
- Anatomic Pathology & Clinical Pathology Physician
- Columbia, MO
National Provider Identifier
1356365506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 2006029248
- Practice address
- 300 Portland St Ste 110
Columbia, MO 65201-7390 - Phone
- (573) 886-4600
- Fax
- (573) 886-4695
- NPI assigned
- Jul 27, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 2006029248 | MO | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 2006029248 | MO | Primary |
Addresses
Primary practice location
300 Portland St Ste 110
Columbia, MO 65201-7390
Mailing address
300 Portland St Ste 110
Columbia, MO 65201-7390
Phone (573) 886-4600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 109840003 | Medicaid | MO |
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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Past | Accepting new patients | |
| Boyce - Bynum Pathology Laboratories, Inc | Clinical Medical Laboratory | 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.
-
- Clinical Medical Laboratory
- Columbia, MO
- NPI 1205896594
-
dba Ozarks Healthcare
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650412800000",
"number": "1356365506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 PORTLAND ST STE 110",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652017390",
"telephone_number": "573-886-4600",
"fax_number": "573-886-4695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 PORTLAND ST STE 110",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652017390",
"telephone_number": "573-886-4600",
"fax_number": "573-886-4695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONES",
"first_name": "JACK",
"middle_name": "D",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2022-04-20",
"certification_date": "2022-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "MO",
"license": "2006029248",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MO",
"license": "2006029248",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "109840003",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.