Active NPI
Tommy Jackson
- Orthopedic Assistant
- Long Beach, CA
National Provider Identifier
1497297154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Assistant
- License
- 02-0922
- Practice address
- 1760 Termino Ave
208
Long Beach, CA 90804-2105 - Phone
- (562) 961-5655
- Fax
- (562) 961-8836
- NPI assigned
- Nov 12, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Assistant | 246ZX2200X | 02-0922 | CA | Primary |
Addresses
Primary practice location
1760 Termino Ave
208
Long Beach, CA 90804-2105
Mailing address
1760 Termino Ave
208
Long Beach, CA 90804-2105
Phone (562) 961-5655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02-0922 | Other | CA | NATIONAL BOARD FOR CERTIFICATION OF ORTHOPAEDIC TECHNOLOGISTS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02-0922 | CA | MD | Orthopedic Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478908800000",
"number": "1497297154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1760 TERMINO AVE",
"address_2": "208",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908042105",
"telephone_number": "562-961-5655",
"fax_number": "562-961-8836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1760 TERMINO AVE",
"address_2": "208",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908042105",
"telephone_number": "562-961-5655",
"fax_number": "562-961-8836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TOMMY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-12",
"last_updated": "2016-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "246ZX2200X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Orthopedic Assistant",
"state": "CA",
"license": "02-0922",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL BOARD FOR CERTIFICATION OF ORTHOPAEDIC TECHNOLOGISTS",
"identifier": "02-0922",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.