NPIMap

Individual provider Active NPI

William J Jackson, MD

  • Family Medicine Physician
  • Shelbyville, KY
National Provider Identifier
1447288709
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
18425 Issued in KY
Practice address
148 Midland Blvd
Shelbyville, KY 40065-9734
Phone
(502) 647-1958
Fax
(502) 647-1940
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 18425 KY Primary

Addresses

Primary practice location

148 Midland Blvd
Shelbyville, KY 40065-9734

Mailing address

148 Midland Blvd
Shelbyville, KY 40065-9734
Phone (502) 647-1958

Other identifiers 2

IdentifierTypeStateIssuer
64184252MedicaidKY
000000273132OtherKYBCBS

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
18425KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kentuckiana Emergency Physicians, PLLC Past Accepting new patients
Jackson Healthcare LLC Past Accepting new patients
Kentuckiana Emergency Physicians Past Accepting new patients
Central Kentucky Emergency Services P.S.C. Past Accepting new patients
Jackson Healthcare Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1447288709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 MIDLAND BLVD",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400659734",
            "telephone_number": "502-647-1958",
            "fax_number": "502-647-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 MIDLAND BLVD",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400659734",
            "telephone_number": "502-647-1958",
            "fax_number": "502-647-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "WILLIAM",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "18425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64184252",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000273132",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelbyville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.