NPIMap

Individual provider Active NPI

Lawrence Richard Jackson Jr., MD

  • Family Medicine Physician
  • Waverly, TN
National Provider Identifier
1386794816
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD0000020215 Issued in TN
Practice address
104 Hillwood Dr
Waverly, TN 37185-2116
Phone
(931) 296-3555
Fax
(931) 296-9085
NPI assigned
Jan 10, 2007
Last updated
Aug 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20215 TN
Family Medicine Physician 207Q00000X MD0000020215 TN Primary

Addresses

Primary practice location

104 Hillwood Dr
Waverly, TN 37185-2116

Mailing address

PO Box 270
Waverly, TN 37185-0270
Phone (931) 296-3555

Other identifiers 3

IdentifierTypeStateIssuer
223121700OtherTNDEPT OF LABOR
0151975OtherTNBCBS
3724150MedicaidTN

Other names 1

  • Dr. Lawrence Jackson Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090702000018 TN Practitioner - Family PracticePractitioner - Emergency Medicine 5698764298 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lawrence Richard Jackson Jr MDGroup PAC ID 1557350154, 2 clinicians

Practice addresses (Care Compare)

104 Hillwood Dr
Waverly, TN 37185-2116
Phone (931) 296-3555

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.56 of 100Reported as apm
Quality
52.91
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
20215TNMDFamily Medicine Physician
MD0000020215TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Medical Group of Texas PLLC CurrentSince Nov 7, 2017 Accepting new patients
South Central Physicians PLLC CurrentSince Jul 9, 2020 Accepting new patients
Concord Medical Group PLLC CurrentSince Nov 7, 2017 Accepting new patients
Lawrence Richard Jackson Jr. MD Family Medicine CurrentSince Nov 14, 1989 Accepting new patients
Humphreys County Community Health Services, Inc. CurrentSince May 25, 2009 Accepting new patients
Humphreys County Community Health Services Inc CurrentSince May 25, 2009 Accepting new patients

Locations

9400 Rhea County Hwy
Dayton, TN 37321
Phone (423) 285-5220

5001 E Main St
Erin, TN 37061
Phone (336) 944-6420

104 Hillwood Dr
Waverly, TN 37185
Phone (931) 296-3555

102 Hillwood Dr
Waverly, TN 37185
Phone (615) 441-4503

451 Highway 13 S
Waverly, TN 37185
Phone (931) 296-0211

Interoperability endpoints

  • Direct secure messaging: lawrencejackson@wfm.allscriptsdirect.net
  • Direct secure messaging: lawrence.jackson.1@33486.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1386794816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371850270",
            "telephone_number": "931-296-3555",
            "fax_number": "931-296-9085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 HILLWOOD DR",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371852116",
            "telephone_number": "931-296-3555",
            "fax_number": "931-296-9085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LAWRENCE",
        "middle_name": "RICHARD",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2023-08-07",
        "certification_date": "2022-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "20215",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD0000020215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "223121700",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0151975",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3724150",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAWRENCE",
            "last_name": "JACKSON",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Waverly, TN

Sources for this page

Verify at the official NPI Registry.