Philip Jackson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301025901 Issued in MI

Practice address

2500 Hamlin Dr
Inkster, MI 48141-2348

Phone

(313) 561-5100

Fax

(313) 565-0309

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Hamilton Community Health Network Inc.

  • Federally Qualified Health Center (FQHC)
  • Flint, MI
  • NPI 1386624278
  NPD (past)

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256083200000",
    "number": "1437174638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26650 EUREKA RD",
            "address_2": "SUITE C-1",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481804835",
            "telephone_number": "734-941-4991",
            "fax_number": "734-941-4919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 HAMLIN DR",
            "city": "INKSTER",
            "state": "MI",
            "postal_code": "481412348",
            "telephone_number": "313-561-5100",
            "fax_number": "313-565-0309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PHILIP",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2009-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301025901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN HAN",
            "identifier": "1020381",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE MMMI",
            "identifier": "17572",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN BLUE CHOICE FENTON",
            "identifier": "350D410030",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "700H228520",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4737508",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1437174638",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4859153",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS MMMI",
            "identifier": "0994622",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS  MMMI",
            "identifier": "350D410030",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryl Lee Ivie
• Shyamala Iyer, RPT
• Dominek Jackson
• Joneetha Christel Jackson
• Kiesha Jackson
• Emani Summer Jacobs, LLMSW
• Shamakia Renee James
• Michael Frank Jermov, DDS
• J'la Miishl Jernigan
• Jewell Health Solutions, LLC

• Pediatrics Physician in Inkster, MI
• Providers in Inkster, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.