Randolph Thomas Jackson, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

31896 Issued in KS

Practice address

11010 Haskell Ave
Kansas City, KS 66109-8500

Phone

(816) 478-1230

Fax

(816) 350-4166

NPI assigned

Mar 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO, KS2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Ophthalmology

Education

Medical College of Georgia School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Care LLCGroup PAC ID 4385544600, shared by 2 NPIs, 49 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rjackson@direct.dvc.nextgenshare.com

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.

• Eye Care, LLC

  dba Discover Vision Centers

  • Optometrist
  • Leawood, KS
  • NPI 1881884211

  Ophthalmology

  Medicare reassignment NPD
• Discover Eye Surgery Center, LLC

  dba Eye Surgery Center - The Cliffs

  • Ambulatory Surgical Clinic/Center
  • Independence, MO
  • NPI 1861485138
  Medicare reassignment NPD
• Eye Care, LLC

  dba Discover Vision Centers

  • Ophthalmology Physician
  • Harrisonville, MO
  • NPI 1609066034
  Medicare reassignment NPD
• Eye Care, LLC

  dba Discover Vision Centers

  • Optometrist
  • Raymore, MO
  • NPI 1023597127

  Ophthalmology

  NPD
• Eye Care LLC

  dba Discover Vision Centers

  • Ophthalmology Physician
  • Independence, MO
  • NPI 1750374567
  NPD (past)

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

{
    "created_epoch": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241654400000",
    "number": "1457310518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 S CLIFF AVE",
            "address_2": "SUITE 100",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640557015",
            "telephone_number": "816-350-4536",
            "fax_number": "816-350-4585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11010 HASKELL AVE",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661098500",
            "telephone_number": "816-478-1230",
            "fax_number": "816-350-4166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RANDOLPH",
        "middle_name": "THOMAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-18",
        "last_updated": "2009-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "46566",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MT",
            "license": "10506",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "KS",
            "license": "31896",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "2006012805",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00685107",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Alexa Jackson, PT, DPT, SCS
• Kelsey Nicole Jackson, APRN-CNP
• Lateasha C Jackson
• Mollie J Jackson, DO
• Quinn Michelle Jackson, M.D.
• Robert Sean Jackson, M.D.
• Sara Jackson, LSCSW
• Seth Jackson, DPT
• Susan T Jackson, PHD, MSC
• Tara L Jackson, APRN

• Ophthalmology Physician in Kansas City, KS
• Providers in Kansas City, KS by specialty
• Ophthalmology Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.