Kimberly Ann Funches-Jackson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

056705 Issued in GA

Practice address

1810 Stadium Dr
Suite 210
Phenix City, AL 36867-3177

Phone

(334) 297-1085

NPI assigned

May 11, 2006

Last updated

Feb 27, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Mississippi School of Medicine, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Prohealth Home Health Home health agency, Auburn, AL, CCN 017063
• Piedmont Columbus Regional Midtown Hospital, Columbus, GA, CCN 110064

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jacksons Point of Light Family Medicine Inc.

  dba JPL Family Medicine, Inc

  • Family Medicine Physician
  • Phenix City, AL
  • NPI 1578758553
  Medicare reassignment NPD
• Houston Hospitals Inc

  dba Emory Hospital Warner Robins

  • General Acute Care Hospital
  • Warner Robins, GA
  • NPI 1962435792
  NPD
• Georgia Department of Human Resources

  dba West Central Georgia Regional Hospital

  • Psychiatric Hospital
  • Columbus, GA
  • NPI 1144224767
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Prohealth Home Health, LLC

  dba ProHealth Home Health

  • Home Health Agency
  • Birmingham, AL
  • NPI 1194324624
  Care Compare affiliation
• The Medical Center Inc

  dba Piedmont Columbus Regional Midtown

  • General Acute Care Hospital
  • Columbus, GA
  • NPI 1255401519
  Care Compare affiliation

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488153600000",
    "number": "1497705123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1045",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "368681045",
            "telephone_number": "334-291-5255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 STADIUM DR",
            "address_2": "SUITE 210",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "368673177",
            "telephone_number": "334-297-1085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNCHES-JACKSON",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2017-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "056705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA LICENSE",
            "identifier": "056705",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "26806",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erica Fox, LCSW
• Fresenius Kidney Care Phenix City, LLC (Fresenius Kidney Care Phenix City)
• Philecia Renee Fuller, HOME CARE PROVIDER
• Farrah-Amoy W. Fullerton, MD
• Tiffani Marie Fulmer, PHARMD
• Justin Lee Fussell, PHARMD
• Jocelyn Galang-Ray, DDS
• Gary Keogh, MD, LLC
• Meleesa Geathers
• Emily Roden Gentry, PHARMD

• Family Medicine Physician in Phenix City, AL
• Providers in Phenix City, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.