Jackson Medical Center PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

JACKSON MEDICAL CENTER PC

Practice address

2387 W Jackson Blvd
Jackson, MO 63755-3024

Phone

(573) 243-9288

Fax

(573) 204-7074

NPI assigned

Dec 5, 2007

Organization subpart

No

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

Authorized official

Name

Stacey L Cantrell

Title

Manager

Phone

(573) 335-1779

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles S Pewitt, DO

  • Family Medicine Physician
  • Jackson, MO
  • NPI 1740389980
  Medicare reassignment NPD

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602028800000",
    "number": "1508048125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2387 W JACKSON BLVD",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637553024",
            "telephone_number": "573-243-9288",
            "fax_number": "573-204-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2387 W JACKSON BLVD",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637553024",
            "telephone_number": "573-243-9288",
            "fax_number": "573-204-7074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON MEDICAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A",
        "authorized_official_last_name": "CANTRELL",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "573-335-1779"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J.U.S.T. Orthotics
• Jackson Dental
• Jackson Dental, LLC
• Jackson Family Clinic, Inc
• Jackson Manor Healthcare, LLC
• Jackson Pharmacy Inc
• Jackson Pharmacy Inc
• Jackson Physical Therapy & Rehabilitation, Inc.
• Jackson Primary Care LLC
• Jackson Primary Care LLC

• Family Medicine Physician in Jackson, MO
• Providers in Jackson, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.