Active NPI
Paul Jackson
- Peer Specialist
- Omaha, NE
National Provider Identifier
1376014555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 11550 I St Ste 100
Omaha, NE 68137-1222 - Phone
- (402) 498-4700
- Fax
- (402) 493-3340
- NPI assigned
- Dec 16, 2018
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | NE | Primary |
Addresses
Primary practice location
11550 I St Ste 100
Omaha, NE 68137-1222
Mailing address
11550 I St Ste 100
Omaha, NE 68137-1222
Phone (402) 498-4700
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544918400000",
"number": "1376014555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11550 I ST STE 100",
"city": "OMAHA",
"state": "NE",
"postal_code": "681371222",
"telephone_number": "402-498-4700",
"fax_number": "402-493-3340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11550 I ST STE 100",
"city": "OMAHA",
"state": "NE",
"postal_code": "681371222",
"telephone_number": "402-498-4700",
"fax_number": "402-493-3340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "PAUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-12-16",
"last_updated": "2018-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NE",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.