Jackson V Gibson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

27189 Issued in NC

Practice address

15 Regional Dr
Pinehurst, NC 28374-8850

Phone

(910) 255-4400

Fax

(910) 420-1608

NPI assigned

Jun 16, 2006

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 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Pinehurst Medical Clinic, Inc.

  dba PMC Reference Lab

  • Clinical Medical Laboratory
  • Southern Pines, NC
  • NPI 1962509372
  NPD (past)

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458172800000",
    "number": "1578507596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 PAGE RD",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748798",
            "telephone_number": "910-295-5511",
            "fax_number": "910-420-1608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 REGIONAL DR",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748850",
            "telephone_number": "910-255-4400",
            "fax_number": "910-420-1608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JACKSON",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2016-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "27189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCAROLINACARE PROV.#",
            "identifier": "FH1000130",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8935323",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA PROVIDER#",
            "identifier": "110081949",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC MEDICAID PROVIDER#",
            "identifier": "Q27189",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS NC PROVIDER#",
            "identifier": "35323",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "0401871",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST PROVIDER#",
            "identifier": "80140",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline B. Gibbons, P.A.
• Joseph Gibbons
• Gibmed PLLC
• Desek Coray Gibson, PA-C
• Heather Driessner Gibson, PHARMD
• Stacey Barber Gilman, COTA/L
• Evelyse Selina Glancy
• Janiah Glapion
• Anne Glashan, AUD
• Cecelia Marie Glaubitz, FNP-C

• Internal Medicine Physician in Pinehurst, NC
• Providers in Pinehurst, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.