Active NPI
Deeanne S Jackson, M.D.
- Pediatrics Physician
- Birmingham, AL
National Provider Identifier
1407876402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 15540
- Practice address
- 1616 6TH Ave S
Birmingham, AL 35233-1788 - Phone
- (205) 939-9585
- Fax
- (205) 975-6503
- NPI assigned
- Jul 20, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 15540 | AL | Primary |
Addresses
Primary practice location
1616 6TH Ave S
Birmingham, AL 35233-1788
Mailing address
703 Volker Hall
Birmingham, AL 35294-0001
Phone (205) 934-3795
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000028944 | Medicaid | AL | |
| 510-25149 | Other | AL | BC BS |
| 000025149 | Medicaid | AL | |
| E89479 | Other | VIVA | |
| 009999685 | Medicaid | AL |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Alabama at Birmingham | Past | Accepting new patients |
Interoperability endpoints
- djackson20462@childrensofalabama.direct-ci.com
- dsjackson@direct.uabmedicine.org
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
- Birmingham, AL
- NPI 1154435824
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294963200000",
"number": "1407876402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "703 VOLKER HALL",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352940001",
"telephone_number": "205-934-3795",
"fax_number": "205-975-2499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1616 6TH AVE S",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352331788",
"telephone_number": "205-939-9585",
"fax_number": "205-975-6503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DEEANNE",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-20",
"last_updated": "2011-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AL",
"license": "15540",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000028944",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS",
"identifier": "510-25149",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000025149",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VIVA",
"identifier": "E89479",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009999685",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.