NPIMap

Organization Active NPI

Jackson Medical Associates, PLLC

  • Family Medicine Physician
  • Ripley, WV
National Provider Identifier
1467675769
Registry record updated Nov 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1524 Issued in WV
Legal business name
JACKSON MEDICAL ASSOCIATES, PLLC
Practice address
122 Pinnell Street
Ripley, WV 25271
Phone
(304) 372-3506
Fax
(304) 372-3523
NPI assigned
Apr 11, 2007
Last updated
Nov 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2011

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

Authorized official

Name
Mrs. Jill Chambers
Title
Office Manager
Phone
(304) 372-3506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 1524 WV Primary

Addresses

Primary practice location

122 Pinnell Street
Ripley, WV 25271

Mailing address

PO Box 171
Ripley, WV 25271-0171
Phone (304) 372-3506

Other identifiers 2

IdentifierTypeStateIssuer
001722717OtherWVBLUE CROSS BLUE SHIELD
0203269000MedicaidWV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320105600000",
    "number": "1467675769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 171",
            "city": "RIPLEY",
            "state": "WV",
            "postal_code": "252710171",
            "telephone_number": "304-372-3506",
            "fax_number": "304-372-3523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 PINNELL STREET",
            "city": "RIPLEY",
            "state": "WV",
            "postal_code": "25271",
            "telephone_number": "304-372-3506",
            "fax_number": "304-372-3523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON MEDICAL ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2011-11-01",
        "status": "A",
        "authorized_official_last_name": "CHAMBERS",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-372-3506",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "1524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "001722717",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0203269000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ripley, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; 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.