John Richard Jackson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E8587 Issued in TX

Practice address

1290 Wonder World Dr Ste 1100
San Marcos, TX 78666-7969

Phone

(512) 393-3325

Fax

(512) 393-3328

NPI assigned

Jul 18, 2005

Last updated

Jan 24, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA, TX2 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

Family Practice

Education

University of Texas Medical School at Houston, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellmed Medical Group PAGroup PAC ID 4880657386, 666 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus Santa Rosa Hospital-San Marcos Hospital, San Marcos, TX, CCN 450272

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: john.jackson@wellmed.eclinicaldirectplus.com
• Direct secure messaging: nfmuc_hollysprings@northside.gwaydirect.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.

• Wellmed Medical Group, PA

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1437156486

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Emergency Coverage, LLC

  dba Emergency Coverage Corporation of TeamHealth

  • Family Medicine Physician
  • Newport, TN
  • NPI 1427005008

  GA

  Medicare reassignment NPD
• Peach Emergency Group LLC

  • Emergency Medicine Physician
  • Byron, GA
  • NPI 1902165327
  Medicare reassignment NPD
• Wellmed Medical Group, P.a.

  dba WellMed Doctor's Hospital Senior Clinic

  • Family Medicine Physician
  • Corpus Christi, TX
  • NPI 1740588243
  NPD
• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Hiram, GA
  • NPI 1437194156
  NPD
• The Hospital Authority of Monroe County, Georgia

  dba Monroe County Hospital

  • Critical Access Hospital
  • Forsyth, GA
  • NPI 1770684284
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Christus Santa Rosa Health Care Corporation

  dba Christus Santa Rosa Hospital - New Braunfels

  • General Acute Care Hospital
  • New Braunfels, TX
  • NPI 1114725033
  Care Compare affiliation
• Christus Santa Rosa Health Care Corporation

  dba Christus Santa Rosa Hospital - San Marcos

  • General Acute Care Hospital
  • San Marcos, TX
  • NPI 1447883301
  Care Compare affiliation

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1457350902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 WONDER WORLD DR STE 1100",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786667969",
            "telephone_number": "512-393-3325",
            "fax_number": "512-393-3328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 WONDER WORLD DR STE 1100",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786667969",
            "telephone_number": "512-393-3325",
            "fax_number": "512-393-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOHN",
        "middle_name": "RICHARD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-18",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "056102",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "E8587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157509345A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NFMUC_HollySprings@Northside.gwaydirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "7768 Cumming Hwy",
            "address_2": "Suite 300",
            "city": "Canton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301149314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Inspired Senior Living of San Marcos Mt LLC (Volante of San Marcos)
• Teresa Lynn Irwin, MD
• Gladys C. Isaacs, PT
• Amanda Michelle Ivy, MD
• Cassandra Lee Jackson, LPC
• Shelley Douglas Jackson, MS, LPC-S, LCDC
• Hayden Riley Jaco
• Randa Danielle Jacobsen, NP-C
• Arthur Ray Jacobson, MD
• Jairo L Bermudez MD, PA

• Family Medicine Physician in San Marcos, TX
• Providers in San Marcos, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; 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.