NPIMap

Individual provider Active NPI

Phillip Corey Jackson, MD PA

  • Family Medicine Physician
  • Harrison, AR
National Provider Identifier
1548227481
Registry record updated Aug 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E3074 Issued in AR
Practice address
1417 Gladden St
Harrison, AR 72601-5121
Phone
(870) 741-0016
Fax
(870) 741-4242
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E3074 AR Primary

Addresses

Primary practice location

1417 Gladden St
Harrison, AR 72601-5121

Mailing address

1417 Gladden St
Harrison, AR 72601-5121
Phone (870) 741-0016

Other identifiers 2

IdentifierTypeStateIssuer
146189001MedicaidAR
5M007OtherARBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040505001430 AR Practitioner - Family Practice 4082602131 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in Shreveport, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baxter County Regional Hospital IncGroup PAC ID 0042389264, 75 clinicians

Practice addresses (Care Compare)

1417 Gladden St
Harrison, AR 72601-2236
Phone (870) 741-0016

Hospital & facility affiliations

  • Baxter Health Hospital, Mountain Home, AR, CCN 040027
  • North Arkansas Regional Medical Center Hospital, Harrison, AR, CCN 040017

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E3074ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baxter County Regional Hospital Inc Family Medicine CurrentSince Sep 3, 2024 Accepting new patients
Baxter County Regional Hospital, Inc Family Medicine Current Accepting new patients
Baxter County Regional Hospital, Inc Family Medicine CurrentSince Sep 3, 2024 Accepting new patients
University of Arkansas for Medical Sciences Family Medicine Past Accepting new patients
University of Arkansas for Medical Sciences Family Medicine Past Accepting new patients
Sam Scroggins MD PA Family Medicine Past Accepting new patients
Washington Regional Medical System Past Accepting new patients
Baxter County Regional Hospital Inc Past Accepting new patients
Arkansas Gatewood Emergency Room Services, PA Past Accepting new patients
QHG of Springdale Inc Past Accepting new patients

Locations

115 Orendorff Ave
Harrison, AR 72601
Phone (870) 741-3438

1417 Gladden St
Harrison, AR 72601
Phone (870) 741-0016

Interoperability endpoints

  • Direct secure messaging: phillip.jackson@bhcawp.eclinicaldirectplus.com

Organizations & group practices 10

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

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407715200000",
    "number": "1548227481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 GLADDEN ST",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726015121",
            "telephone_number": "870-741-0016",
            "fax_number": "870-741-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 GLADDEN ST",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726015121",
            "telephone_number": "870-741-0016",
            "fax_number": "870-741-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PHILLIP",
        "middle_name": "COREY",
        "name_prefix": "Dr.",
        "credential": "MD  PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2014-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E3074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146189001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5M007",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrison, AR

Sources for this page

Verify at the official NPI Registry.