Active NPI
Richard T Jackson, D.P.M.
- Podiatrist
- Fort Wayne, IN
National Provider Identifier
1407859424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 07000729A
- Practice address
- 7601 W Jefferson Blvd
Fort Wayne, IN 46804-4133 - Phone
- (260) 436-8686
- Fax
- (260) 486-8585
- NPI assigned
- May 23, 2005
- 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 07000729A | IN | Primary |
Addresses
Primary practice location
7601 W Jefferson Blvd
Fort Wayne, IN 46804-4133
Mailing address
PO Box 2526
Fort Wayne, IN 46801-2526
Phone (260) 436-8686
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100359040A | Medicaid | IN | |
| 480026551 | Other | RAILROAD MEDICARE | |
| 00000089403 | Other | ANTHEM |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | 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 and National Provider Directory roles.
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478476800000",
"number": "1407859424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2526",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468012526",
"telephone_number": "260-436-8686",
"fax_number": "260-436-8585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7601 W JEFFERSON BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044133",
"telephone_number": "260-436-8686",
"fax_number": "260-486-8585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RICHARD",
"middle_name": "T",
"credential": "D.P.M.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-23",
"last_updated": "2016-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "IN",
"license": "07000729A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100359040A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "480026551",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "00000089403",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.