NPIMap

Individual provider Active NPI

Thomas Jackson

  • Periodontics
  • Barrington, IL
National Provider Identifier
1447595814
Registry record updated Dec 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
021.002086 Issued in IL
Practice address
205 W Main St
Barrington, IL 60010-4205
Phone
(847) 842-6900
Fax
(847) 842-6966
NPI assigned
Dec 11, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 021.002086 IL Primary

Addresses

Primary practice location

205 W Main St
Barrington, IL 60010-4205

Mailing address

205 W Main St
Barrington, IL 60010-4205
Phone (847) 842-6900

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

State licenses

LicenseStateTypeSpecialty
021.002086ILMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Pain Consultants, S.C. Past Accepting new patients
The Chicago Center for Cosmetic and Implant Dentis Periodontics Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355184000000",
    "number": "1447595814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W MAIN ST",
            "city": "BARRINGTON",
            "state": "IL",
            "postal_code": "600104205",
            "telephone_number": "847-842-6900",
            "fax_number": "847-842-6966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W MAIN ST",
            "city": "BARRINGTON",
            "state": "IL",
            "postal_code": "600104205",
            "telephone_number": "847-842-6900",
            "fax_number": "847-842-6966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "THOMAS",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-12-11",
        "last_updated": "2012-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021.002086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Barrington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; 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.