Allen Charles Jackson, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

R3563 Issued in AR

Practice address

624 Hospital Dr
Mountain Home, AR 72653-2955

Phone

(870) 365-2076

NPI assigned

Nov 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• John Patton Black,MD

  • Personal Emergency Response Attendant
  • Mountain Home, AR
  • NPI 1194766584
  NPD (past)
• Nes Arkansas, Inc.

  • Emergency Medicine Physician
  • El Dorado, AR
  • NPI 1184615551
  NPD (past)
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550534400000",
    "number": "1477544955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726541449",
            "telephone_number": "870-424-3181",
            "fax_number": "870-424-3089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 HOSPITAL DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532955",
            "telephone_number": "870-365-2076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALLEN",
        "middle_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2019-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "R3563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112301001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia Ann Hutchison, PHARM.D.,
• Icd Inc
• Inspirational Insight Counseling
• Interventional Pain Management Associates PLLC
• J Harley Barrow Jr MD PLLC
• Kelsey Jackson, COTA
• Quinci Jackson
• Laurie Ann. James, LCSW
• Theresa Ann Jaques, MHPP
• Laura E Jarrett, LMSW

• Emergency Medicine Physician in Mountain Home, AR
• Providers in Mountain Home, AR by specialty
• Emergency Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; 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.