Individual provider Active NPI

Andrew P Jackson, D.D.S.

  • Dentist
  • New Iberia, LA
National Provider Identifier
1356382485
Registry record updated Oct 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4368 Issued in LA
Practice address
806 Jefferson Ter
New Iberia, LA 70560
Phone
(337) 365-4945
NPI assigned
Jun 9, 2006
Last updated
Oct 16, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 4368 LA Primary

Addresses

Primary practice location

806 Jefferson Ter
New Iberia, LA 70560

Mailing address

806 Jefferson Ter
New Iberia, LA 70560-5727
Phone (337) 365-4945

Other practice location 1

1004 Surrey St
Lafayette, LA 70501-6143
Phone (337) 456-6768

Other practice location 2

317 Dernier St
Saint Martinville, LA 70582-3809
Phone (337) 342-2566

Other practice location 3

1009 Charity St
Abbeville, LA 70510-5302
Phone (337) 893-3443

Other practice location 4

806 Jefferson Ter
New Iberia, LA 70560
Phone (337) 365-4945

Other identifiers 1

IdentifierTypeStateIssuer
1843687MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160223002188 LA Order and Referring Only - DentistPractitioner - Dentist 4587969902

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4368LAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Iberia Comprehensive Community Health Center, Inc. Past Accepting new patients
Iberia Comprehensive Community Health Center,Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: andrew.jackson@icchc.eclinicaldirectplus.com

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": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571184000000",
    "number": "1356382485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 JEFFERSON TER",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705605727",
            "telephone_number": "337-365-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 JEFFERSON TER",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "70560",
            "telephone_number": "337-365-4945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1004 Surrey St",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "LA",
            "postal_code": "705016143",
            "country_code": "US",
            "telephone_number": "337-456-6768",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "317 Dernier St",
            "address_purpose": "LOCATION",
            "city": "Saint Martinville",
            "state": "LA",
            "postal_code": "705823809",
            "country_code": "US",
            "telephone_number": "337-342-2566",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1009 Charity St",
            "address_purpose": "LOCATION",
            "city": "Abbeville",
            "state": "LA",
            "postal_code": "705105302",
            "country_code": "US",
            "telephone_number": "337-893-3443",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "806 Jefferson Ter",
            "address_purpose": "LOCATION",
            "city": "New Iberia",
            "state": "LA",
            "postal_code": "70560",
            "country_code": "US",
            "telephone_number": "337-365-4945",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANDREW",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2019-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "4368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1843687",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Iberia, LA

Sources for this page

Verify at the official NPI Registry.