Michael R. Jackson, M.D. P.S.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0019523 Issued in WA

Legal business name

MICHAEL R. JACKSON, M.D. P.S.

Practice address

5350 Orchard St W
Suite 202
University Place, WA 98467-4817

Phone

(253) 472-4444

NPI assigned

May 3, 2012

Organization subpart

No

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

Authorized official

Name

Michael R Jackson, M.D.NPI 1043239429

Title

President

Phone

(253) 472-4444

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Reid Jackson, M.D.

  • Family Medicine Physician
  • University Place, WA
  • NPI 1043239429
  NPD Authorized official

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

{
    "created_epoch": "1336003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336003200000",
    "number": "1366701849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5350 ORCHARD ST W",
            "address_2": "SUITE 202",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984674817",
            "telephone_number": "253-472-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5350 ORCHARD ST W",
            "address_2": "SUITE 202",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984674817",
            "telephone_number": "253-472-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL R. JACKSON, M.D. P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-03",
        "last_updated": "2012-05-03",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-472-4444",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "0019523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1077510",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1043239429",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janine Ladawn Messenger, LMP
• Nicholas S. Metz, ATC
• Michelle Angela Metzger, LMP
• John Gary Meyer, M.D.
• Marcy Meyer, M.D.
• Kimberly Shin Michie, PHARMD
• Lavonna Miesse
• Andrea Nichole Miller, AT/C, AT/L
• Cameron Miller
• Emily Hope Milless

• Family Medicine Physician in University Place, WA
• Providers in University Place, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.