James Jackson, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02001724A Issued in IN

Practice address

236 Simpson Ave
Elkhart, IN 46516-4666

Phone

(574) 293-0052

Fax

(574) 293-3744

NPI assigned

Nov 3, 2005

Last updated

Aug 12, 2016By the provider in NPPES

Sex

Male

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470960000000",
    "number": "1548251937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "236 SIMPSON AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465164666",
            "telephone_number": "574-293-0052",
            "fax_number": "574-293-3744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 SIMPSON AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465164666",
            "telephone_number": "574-293-0052",
            "fax_number": "574-293-3744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JAMES",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2016-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02001724A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200482280",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Interventional Pain Specialist PC
• Interventional Spine and Pain, P.C.
• Sheri Irons, MSW
• J E Steele DDS PC
• Darneysia Jackson
• Megan Michelle Jackson, OT
• Neil Sushil Jain, PHARMD
• James L Myers II O.D. P.C.
• Carol A. Jarvis, PH.D., LCSW
• Douglas L. Jarvis, D.O.

• Family Medicine Physician in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.

Verify at the official NPI Registry.