Active NPI
Richard D Jackson, MD
- Family Medicine Physician
- Ronks, PA
National Provider Identifier
1366483406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD031678E
- Practice address
- 29 Eastbrook Rd
Ronks, PA 17572-9769 - Phone
- (717) 299-5711
- NPI assigned
- Jun 9, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD031678E | PA | Primary |
Addresses
Primary practice location
29 Eastbrook Rd
Ronks, PA 17572-9769
Mailing address
29 Eastbrook Rd
Ronks, PA 17572-9769
Phone (717) 299-5711
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1160742 | Medicaid | PA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD031678E | PA | MD | Family Medicine Physician |
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": "1783900800000",
"number": "1366483406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 EASTBROOK RD",
"city": "RONKS",
"state": "PA",
"postal_code": "175729769",
"telephone_number": "717-299-5711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29 EASTBROOK RD",
"city": "RONKS",
"state": "PA",
"postal_code": "175729769",
"telephone_number": "717-299-5711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RICHARD",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-09",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MD031678E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1160742",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ronks, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.