Active NPI
Jo Anne Jackson, DMD
- Pediatric Dentistry
- Birmingham, AL
National Provider Identifier
1487724589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 2563
- Practice address
- 3918 Montclair Rd
Suite 206
Birmingham, AL 35213-2418 - Phone
- (205) 879-6150
- Fax
- (205) 879-6150
- NPI assigned
- Nov 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 2563 | AL | Primary |
Addresses
Primary practice location
3918 Montclair Rd
Suite 206
Birmingham, AL 35213-2418
Mailing address
3918 Montclair Rd
Suite 206
Birmingham, AL 35213-2418
Phone (205) 879-6150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170208001756 | AL | Order and Referring Only - Dentist | 9133402589 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2563 | AL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487724589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3918 MONTCLAIR RD",
"address_2": "SUITE 206",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352132418",
"telephone_number": "205-879-6150",
"fax_number": "205-879-6150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3918 MONTCLAIR RD",
"address_2": "SUITE 206",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352132418",
"telephone_number": "205-879-6150",
"fax_number": "205-879-6150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JO",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "AL",
"license": "2563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.