Billy Jackson

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

1975 S John Young Pkwy Ste 203a
Kissimmee, FL 34741-0603

Phone

(321) 236-1540

NPI assigned

Oct 17, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Serving Children and Reaching Families

  • Community/Behavioral Health Agency
  • Kissimmee, FL
  • NPI 1336588813
  NPD (past)

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

{
    "created_epoch": "1571270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1487297834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 S JOHN YOUNG PKWY STE 203A",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347410603",
            "telephone_number": "321-236-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 S JOHN YOUNG PKWY STE 203A",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347410603",
            "telephone_number": "321-236-1540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BILLY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-17",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.scrffl.com",
            "affiliation": "N",
            "endpointDescription": "Community Based",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1975 S John Young Pkwy Ste 203A",
            "city": "Kissimmee",
            "state": "FL",
            "country_code": "US",
            "postal_code": "347410603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alecia Vanessa Stephanie Jack
• Joyce Jack, RPH
• Otavia Jack
• Pamela D Jackman, M.S CCC-SLP
• Bailey Jackson
• Maureen Ann Jackson, PHARM. D
• Shynetra Jackson
• Brooke Jacobs, OTR/L, OTD
• Karen Jacobs, ARNP
• Jennifer Jacques Lalanne, APRN

• Case Manager/Care Coordinator in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Case Manager/Care Coordinator in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.