NPIMap

Individual provider Active NPI

Keith Lynn Jackson II, MD

  • Orthopaedic Surgery of the Spine Physician
  • Colorado Springs, CO
National Provider Identifier
1578728614
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
DR.0059249 Issued in CO
Practice address
2222 N Nevada Ave Ste 5001
Colorado Springs, CO 80907-6865
Phone
(719) 776-3580
Fax
(719) 776-3599
NPI assigned
Jul 28, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine Physician 207XS0117X DR.0059249 CO Primary
Orthopaedic Surgery of the Spine Physician 207XS0117X 2014-01633 NC

Addresses

Primary practice location

2222 N Nevada Ave Ste 5001
Colorado Springs, CO 80907-6865

Mailing address

2222 N Nevada Ave Ste 5001
Colorado Springs, CO 80907-6865
Phone (719) 776-3580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20180822002560 SC Practitioner - Orthopedic Surgery 9638352099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Georgetown University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1321 Interstate Pkwy
Augusta, GA 30909-5626
Phone (706) 945-0810

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0059249COMDOrthopaedic Surgery of the Spine Physician
2014-01633NCMDOrthopaedic Surgery of the Spine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Jun 23, 2018 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Jun 23, 2018 Accepting new patients
Prisma Health Medical Group-Midlands Current Accepting new patients

Locations

14 Richland Medical Park Dr
Ste 200
Columbia, SC 29203
Phone (803) 296-9200

3555 Harden Street Ext
Ste 300
Columbia, SC 29203
Phone (803) 434-6411

Interoperability endpoints

  • Direct secure messaging: kjackson381060@direct.ghs.myhfn.org

Organizations & group practices 4

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 7

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": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1578728614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 N NEVADA AVE STE 5001",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076865",
            "telephone_number": "719-776-3580",
            "fax_number": "719-776-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 N NEVADA AVE STE 5001",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076865",
            "telephone_number": "719-776-3580",
            "fax_number": "719-776-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KEITH",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "CO",
            "license": "DR.0059249",
            "primary": true
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "NC",
            "license": "2014-01633",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.