Larry Arthur Jackson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD08513 Issued in OR

Practice address

1445 Gateway Blvd
Cottage Grove, OR 97424-1224

Phone

(541) 942-7000

Fax

(541) 942-5550

NPI assigned

Apr 29, 2010

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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.

• Covered Bridge Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Cottage Grove, OR
  • NPI 1609068998
  NPD (past)
• Icco LLC

  dba Cottage Grove Medical Clinic

  • Clinic/Center
  • Cottage Grove, OR
  • NPI 1750492906
  NPD (past)

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

{
    "created_epoch": "1272499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272499200000",
    "number": "1578880548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 607",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974240026",
            "telephone_number": "541-942-7000",
            "fax_number": "541-942-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 GATEWAY BLVD",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974241224",
            "telephone_number": "541-942-7000",
            "fax_number": "541-942-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LARRY",
        "middle_name": "ARTHUR",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-29",
        "last_updated": "2010-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD08513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jared Hutchins, ATC
• McKinley Marie Hutchison, FNP
• Icco LLC (Cottage Grove Medical Clinic)
• Icco, LLC (BestMed)
• Interior Intentions (Dba In2Aging
• Keisha Janney
• Shaunna Jennings, RDH
• Pearl Ann Jobe, PMHNP
• Kimber Leigh Johns
• Diana Marie Johnson, RN, QMRP, CHSP

• Family Medicine Physician in Cottage Grove, OR
• Providers in Cottage Grove, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2010; 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.