Active NPI
Edward William Jackson, MD
- Adult Medicine Physician
- Springville, UT
National Provider Identifier
1487367728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Medicine Physician
- License
- 183721-1205
- Practice address
- 786 S Left Hand Fork Hobble Creek Cyn
Springville, UT 84663-5916 - Phone
- (801) 489-9381
- NPI assigned
- Jan 2, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | 183721-1205 | UT | Primary |
| Family Medicine Physician | 207Q00000X | 183721-1205 | UT |
Addresses
Primary practice location
786 S Left Hand Fork Hobble Creek Cyn
Springville, UT 84663-5916
Mailing address
786 S Left Hand Fork Hobble Creek Cyn
Springville, UT 84663-5916
Phone (801) 489-9381
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 183721-1205 | UT | MD | Adult Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672617600000",
"number": "1487367728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "786 S LEFT HAND FORK HOBBLE CREEK CYN",
"city": "SPRINGVILLE",
"state": "UT",
"postal_code": "846635916",
"telephone_number": "801-489-9381"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "786 S LEFT HAND FORK HOBBLE CREEK CYN",
"city": "SPRINGVILLE",
"state": "UT",
"postal_code": "846635916",
"telephone_number": "801-489-9381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "EDWARD",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-02",
"last_updated": "2023-01-02",
"certification_date": "2023-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "UT",
"license": "183721-1205",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "UT",
"license": "183721-1205",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springville, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.