Active NPI
John Daniel Jackman, MD
- Cardiovascular Disease Physician
- Tyler, TX
National Provider Identifier
1407841646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- H1109
- Practice address
- 619 S Fleishel Ave
Suite 101
Tyler, TX 75701-2004 - Phone
- (903) 595-5514
- NPI assigned
- Sep 14, 2005
- Last updated
- Feb 27, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | H1109 | TX | Primary |
| Interventional Cardiology Physician | 207RI0011X | H1109 | TX |
Addresses
Primary practice location
619 S Fleishel Ave
Suite 101
Tyler, TX 75701-2004
Mailing address
619 S Fleishel Ave
Suite 101
Tyler, TX 75701-2004
Phone (903) 595-5514
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89423J | Other | TX | BCBS |
| 4533990 | Other | TX | AETNA |
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 |
|---|---|---|---|
| H1109 | TX | MD | Interventional Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tyler Cardiovascular Consultants P.a. | Cardiovascular Disease | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Cardiovascular Disease Physician
- Tyler, TX
- NPI 1376538801
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204070400000",
"number": "1407841646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "619 S FLEISHEL AVE",
"address_2": "SUITE 101",
"city": "TYLER",
"state": "TX",
"postal_code": "757012004",
"telephone_number": "903-595-5514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 S FLEISHEL AVE",
"address_2": "SUITE 101",
"city": "TYLER",
"state": "TX",
"postal_code": "757012004",
"telephone_number": "903-595-5514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKMAN",
"first_name": "JOHN",
"middle_name": "DANIEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-14",
"last_updated": "2008-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "TX",
"license": "H1109",
"primary": true
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "TX",
"license": "H1109",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "89423J",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4533990",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.