Active NPI
Michael L Jackson, MD
- Emergency Medicine Physician
- Seymour, IN
National Provider Identifier
1609987494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 01032507A
- Practice address
- 411 W Tipton St
Seymour, IN 47274-2363 - Phone
- (812) 522-2349
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 01032507A | IN | Primary |
Addresses
Primary practice location
411 W Tipton St
Seymour, IN 47274-2363
Mailing address
1155 W 3Rd St
Bloomington, IN 47404-5016
Phone (812) 336-1690
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100331130 | Medicaid | IN | |
| 01032507B | Other | IN | CSR |
| 01032507A | Other | IN | IN LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01032507A | IN | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Emergency Physicians of Memphis LLC | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Alton, IL
- NPI 1437105277
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1609987494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1155 W 3RD ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474045016",
"telephone_number": "812-336-1690",
"fax_number": "812-349-1311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 W TIPTON ST",
"city": "SEYMOUR",
"state": "IN",
"postal_code": "472742363",
"telephone_number": "812-522-2349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHAEL",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IN",
"license": "01032507A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100331130",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSR",
"identifier": "01032507B",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IN LICENSE",
"identifier": "01032507A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seymour, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.