Active NPI
Rodney Mark Jackson, MD,FAAP
- Specialist
- Anthem, AZ
National Provider Identifier
1619975398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 28940
- Practice address
- 3654 W Anthem Way
Suite B-114
Anthem, AZ 85086-0455 - Phone
- (623) 551-0442
- Fax
- (623) 551-7389
- NPI assigned
- Jul 7, 2005
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 28940 | AZ | Primary |
Addresses
Primary practice location
3654 W Anthem Way
Suite B-114
Anthem, AZ 85086-0455
Mailing address
3654 W Anthem Way
Suite B-114
Anthem, AZ 85086-0455
Phone (623) 551-0442
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 576077 | Medicaid | AZ |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28940 | AZ | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1619975398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3654 W ANTHEM WAY",
"address_2": "SUITE B-114",
"city": "ANTHEM",
"state": "AZ",
"postal_code": "850860455",
"telephone_number": "623-551-0442",
"fax_number": "623-551-7389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3654 W ANTHEM WAY",
"address_2": "SUITE B-114",
"city": "ANTHEM",
"state": "AZ",
"postal_code": "850860455",
"telephone_number": "623-551-0442",
"fax_number": "623-551-7389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RODNEY",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "MD,FAAP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-07",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AZ",
"license": "28940",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "576077",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anthem, AZ
- Helene M Illston, M.T.
- Infinite Path Solutions LLC
- Integrity Wound Healing Solutions LLC
- Interaactive Speech Therapy
- Chelsea Lynn Jackson
- Sadaf Jamil, DO
- JH Dental
- JL Shaughnessy Dental Associates
- John C Lincoln LLC (Pinnacle Anthem)
- John C. Lincoln, LLC (dba John C. Lincoln Health Quest Family Medicine)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.