Active NPI
James F Jackson, PA
- Physician Assistant
- Elizabethtown, NY
National Provider Identifier
1467535294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001289
- Practice address
- 75 Park St
Elizabethtown, NY 12932 - Phone
- (518) 873-6377
- Fax
- (518) 873-2315
- NPI assigned
- Oct 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001289 | NY | Primary |
Addresses
Primary practice location
75 Park St
Elizabethtown, NY 12932
Mailing address
34 Windy Wy
PO Box 381
Elizabethtown, NY 12932
Phone (518) 873-6813
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000492668001 | Other | NY | BLUE SHIELD NENY |
| 001289 | Other | NY | STATE LICENSE |
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)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edward John Noble Hospital of Gouverneur Ny | Past | Accepting new patients | |
| Edward John Noble Hospital of Gouverneur Ny Swing Bed Unit | 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 and National Provider Directory roles.
-
- Rural Acute Care Hospital
- Gouverneur, NY
- NPI 1316940745
-
- Medicare Defined Swing Bed Hospital Unit
- Gouverneur, NY
- NPI 1215031885
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1467535294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 WINDY WY",
"address_2": "PO BOX 381",
"city": "ELIZABETHTOWN",
"state": "NY",
"postal_code": "12932",
"telephone_number": "518-873-6813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 PARK ST",
"city": "ELIZABETHTOWN",
"state": "NY",
"postal_code": "12932",
"telephone_number": "518-873-6377",
"fax_number": "518-873-2315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JAMES",
"middle_name": "F",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-23",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "001289",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD NENY",
"identifier": "000492668001",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "001289",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elizabethtown, NY
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.