Thomas Miles Jackson, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

DR48817 Issued in CO

Practice address

2201 San Juan Ave
La Junta, CO 81050-3323

Phone

(719) 384-8181

Fax

(719) 384-4872

NPI assigned

Jul 26, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of Kansas School of Med (KC/Wich/Sal), 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arkansas Valley Regional Medical CenterGroup PAC ID 9436062833, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Arkansas Valley Regional Medical Center Hospital, Lajuna, CO, CCN 061336

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Arkansas Valley Regional Medical Center

  • General Practice Physician
  • La Junta, CO
  • NPI 1649449075

  CO

  Medicare reassignment Care Compare group NPD
• Arkansas Valley Regional Medical Center

  • Critical Access Hospital
  • La Junta, CO
  • NPI 1760489470

  CO

  Medicare reassignment Care Compare group NPD
• Arkansas Valley Regional Medical Center

  • Certified Registered Nurse Anesthetist
  • La Junta, CO
  • NPI 1609320514
  Care Compare group
• Oliver Chiropractic LLC

  • Chiropractor
  • Ottawa, KS
  • NPI 1962471318
  NPD (past)
• Ransom Memorial Hospital

  • Rural Health Clinic/Center
  • Wellsville, KS
  • NPI 1053704734
  NPD (past)
• Searhc

  • General Acute Care Hospital
  • Klowack, AK
  • NPI 1841540929
  NPD (past)
• Searhc Montana Creek Residential Facility

  • Community/Behavioral Health Agency
  • Juneau, AK
  • NPI 1144346024
  NPD (past)
• Searhc Montana Creek Residential Facility

  • Community/Behavioral Health Agency
  • Juneau, AK
  • NPI 1487770491
  NPD (past)
• Searhc- Mt Edgecumbe Hospital

  • Non-emergency Medical Transport (VAN)
  • Sitka, AK
  • NPI 1487981833
  NPD (past)
• South East Alaska Regional Health Consortium

  • Multi-Specialty Clinic/Center
  • Sitka, AK
  • NPI 1235329459
  NPD (past)
• South East Alaska Regional Health Consortium

  • Clinic/Center
  • Klukwan, AK
  • NPI 1306173752
  NPD (past)
• South East Alaska Regional Health Consortium

  • Nursing Facility/Intermediate Care Facility
  • Sitka, AK
  • NPI 1386814473
  NPD (past)

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

• Arkansas Valley Regional Medical Center

  • Critical Access Hospital
  • La Junta, CO
  • NPI 1760489470

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273622400000",
    "number": "1598765083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 CARSON AVE",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "810502751",
            "telephone_number": "719-383-5142",
            "fax_number": "719-383-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 SAN JUAN AVE",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "810503323",
            "telephone_number": "719-384-8181",
            "fax_number": "719-384-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "THOMAS",
        "middle_name": "MILES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2010-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KS",
            "license": "04-21320",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AK",
            "license": "5568",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CO",
            "license": "DR48817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100131110B",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Inspiration Field
• Inspiration Field
• Inspiration Field
• Inspiration Field
• Inspiration Field
• Amar Chand Jetty, MD
• CHI-Ann Dae Johnson, ACNPC-AG
• Elisabeth Dawn Johnson, RN
• Patricia K Johnson, F.N.P.
• Joseph L Collins MD PC

• All providers in La Junta, CO
• Surgery Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.