Active NPI
Andrew P Jackson, D.D.S.
- Dentist
- New Iberia, LA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4368
- Practice address
- 806 Jefferson Ter
New Iberia, LA 70560 - Phone
- (337) 365-4945
- NPI assigned
- Jun 9, 2006
- Last updated
- Oct 16, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1843687 | Medicaid | LA |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160223002188 | LA | Order and Referring Only - Dentist | 4587969902 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4368 | LA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iberia Comprehensive Community Health Center, Inc. | Past | Accepting new patients | |
| Iberia Comprehensive Community Health Center,Inc. | Past | Accepting new patients |
Interoperability endpoints
- 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.
-
dba Abbeville Community Health Center
- Federally Qualified Health Center (FQHC)
- Abbeville, LA
- NPI 1134166556
-
- Federally Qualified Health Center (FQHC)
- New Iberia, LA
- NPI 1922046549
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2019; 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.