NPIMap

Individual provider Active NPI

Morris B Jackson, MD

  • Urology Physician
  • Louisville, KY
National Provider Identifier
1477511921
Registry record updated Jan 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
22181 Issued in KY
Practice address
3920 S Dupont SQ Ste C
Louisville, KY 40207-4615
Phone
(812) 282-3899
Fax
(812) 282-4172
NPI assigned
May 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 22181 KY Primary
Urology Physician 208800000X 01039636A IN

Addresses

Primary practice location

3920 S Dupont SQ Ste C
Louisville, KY 40207-4615

Mailing address

101 Hospital Blvd
Jeffersonville, IN 47130-3769
Phone (812) 282-3899

Other identifiers 4

IdentifierTypeStateIssuer
64221815MedicaidKY
201028460MedicaidIN
P00314088OtherKYRAILROAD MEDICARE
00895267OtherKYRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041028000140 KY Practitioner - Urology 9830151398 Reassigns benefits to 1 organization
I20110328000254 IN Practitioner - Urology 9830151398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Louisville School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
First Urology PSCGroup PAC ID 3779572888, 56 clinicians

Practice addresses (Care Compare)

101 Hospital Blvd
Jeffersonville, IN 47130-3769
Phone (812) 282-3899

2400 Eastpoint Pkwy
Suite 560
Louisville, KY 40223-4154
Phone (502) 897-7172

3 Audubon Plaza Dr
L10
Louisville, KY 40217-1362
Phone (502) 584-0651

300 High Point CT
Mount Washington, KY 40047-6560
Phone (502) 955-6129

309 11TH St
Carrollton, KY 41008-1435
Phone (502) 633-2661

3920 S Dupont SQ C
Louisville, KY 40207-4615
Phone (812) 282-3899

5120 Dixie Hwy
Suite 105
Louisville, KY 40216-1775
Phone (812) 282-3899

515 Hospital Dr
Suite 3
Shelbyville, KY 40065-1619
Phone (502) 633-2661

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01039636AINMDUrology Physician
22181KYMDUrology Physician

Organizations & group practices 1

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.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454025600000",
    "number": "1477511921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL BLVD",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471303769",
            "telephone_number": "812-282-3899",
            "fax_number": "812-282-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3920 S DUPONT SQ STE C",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074615",
            "telephone_number": "812-282-3899",
            "fax_number": "812-282-4172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MORRIS",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2016-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "KY",
            "license": "22181",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IN",
            "license": "01039636A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64221815",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201028460",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00314088",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "00895267",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.