Jackson Primary Care LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

JACKSON PRIMARY CARE LLC

Practice address

2685 E Main St Suite a
Ste a
Jackson, MO 63755

Phone

(573) 204-1400

Fax

(573) 204-1480

NPI assigned

Sep 8, 2005

Last updated

Oct 26, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Deanna M Siemer, MDNPI 1851368153

Title

Owner

Phone

(573) 204-1400

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Tax ID family

Jackson Primary Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jackson Primary Care LLC

  • Primary Care Clinic/Center
  • Jackson, MO
  • NPI 1790213676
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deanna Maria Siemer, MD

  • Family Medicine Physician
  • Jackson, MO
  • NPI 1851368153
  Medicare reassignment NPD Authorized official
• E J Eskew, MS APRN BC

  • Family Medicine Physician
  • Jackson, MO
  • NPI 1942277249
  Medicare reassignment NPD
• Jessica Lynn Malahy, FNP-C

  • Family Nurse Practitioner
  • Jackson, MO
  • NPI 1497504252
  Medicare reassignment NPD

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288051200000",
    "number": "1619961380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2685 E MAIN ST SUITE A",
            "address_2": "STE A",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "63755",
            "telephone_number": "573-204-1400",
            "fax_number": "573-204-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2685 E MAIN ST SUITE A",
            "address_2": "STE A",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "63755",
            "telephone_number": "573-204-1400",
            "fax_number": "573-204-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-08",
        "last_updated": "2010-10-26",
        "status": "A",
        "authorized_official_last_name": "SIEMER",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-204-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "132588",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "509303004",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackson Manor Healthcare, LLC (Jackson Manor)
• Jackson Medical Center PC
• Jackson Pharmacy Inc (Medicenter Pharmacy)
• Jackson Pharmacy Inc (MediCenter Pharmacy)
• Jackson Physical Therapy & Rehabilitation, Inc.
• Jackson Primary Care LLC
• Jackson R-2 Schools
• Stephanie Jansen, DC
• Dwight Hood Johnson, D.D.S.
• Jones Drug Store Inc

• Family Medicine Physician in Jackson, MO
• Providers in Jackson, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.