Active NPI
Michael Vincent Jackson, MD
- Sleep Medicine (Internal Medicine) Physician
- Reno, NV
National Provider Identifier
1487637922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sleep Medicine (Internal Medicine) Physician
- License
- 4867
- Practice address
- 236 W 6TH St
Ste 100
Reno, NV 89503-4517 - Phone
- (775) 982-5000
- Fax
- (775) 982-3900
- NPI assigned
- Nov 29, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | 4867 | NV | |
| Pulmonary Disease Physician | 207RP1001X | 4867 | NV | |
| Sleep Medicine (Internal Medicine) Physician | 207RS0012X | 4867 | NV | Primary |
Addresses
Primary practice location
236 W 6TH St
Ste 100
Reno, NV 89503-4517
Mailing address
850 Harvard Way
Reno, NV 89502-2055
Phone (775) 982-5262
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002016249 | Medicaid | NV |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4867 | NV | MD | Pulmonary Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513728000000",
"number": "1487637922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 HARVARD WAY",
"city": "RENO",
"state": "NV",
"postal_code": "895022055",
"telephone_number": "775-982-5262",
"fax_number": "775-982-5496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "236 W 6TH ST",
"address_2": "STE 100",
"city": "RENO",
"state": "NV",
"postal_code": "895034517",
"telephone_number": "775-982-5000",
"fax_number": "775-982-3900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHAEL",
"middle_name": "VINCENT",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-29",
"last_updated": "2017-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "NV",
"license": "4867",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "NV",
"license": "4867",
"primary": false
},
{
"code": "207RS0012X",
"taxonomy_group": "",
"desc": "Internal Medicine, Sleep Medicine",
"state": "NV",
"license": "4867",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002016249",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Reno, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.