Active NPI
David A. Jackson, M.D.
- Internal Medicine Physician
- Pinon, AZ
National Provider Identifier
1508000480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 35.099840
- Practice address
- Navajo Route 4
Pinon Health Center
Pinon, AZ 86510 - Phone
- (928) 725-9500
- NPI assigned
- Apr 23, 2009
- Last updated
- Jan 8, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35.099840 | OH | Primary |
| Pediatrics Physician | 208000000X | 35.099840 | OH |
Addresses
Primary practice location
Navajo Route 4
Pinon Health Center
Pinon, AZ 86510
Mailing address
PO Box 10
Pinon, AZ 86510-0010
Phone (928) 725-9500
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 |
|---|---|---|---|
| 35.099840 | OH | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phillip Tutnauer DPM | Past | Accepting new patients | |
| DHHS PHS Naihs Chinle Comprehensive Health Care Facility | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Pinon Health Center Behavioral Health
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Pinon, AZ
- NPI 1598266876
-
dba Hamilton Footcare Center
- Foot & Ankle Surgery Podiatrist
- Pinon, AZ
- NPI 1194962365
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389139200000",
"number": "1508000480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10",
"city": "PINON",
"state": "AZ",
"postal_code": "865100010",
"telephone_number": "928-725-9500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "NAVAJO ROUTE 4",
"address_2": "PINON HEALTH CENTER",
"city": "PINON",
"state": "AZ",
"postal_code": "86510",
"telephone_number": "928-725-9500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DAVID",
"middle_name": "A.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-23",
"last_updated": "2014-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OH",
"license": "35.099840",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35.099840",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pinon, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.