Active NPI
Billy Michael Jackson, MD
- Surgery Physician
- Los Alamos, NM
National Provider Identifier
1629076864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 72160
- Practice address
- 3917 West Rd
Suite 150
Los Alamos, NM 87544 - Phone
- (505) 662-4351
- Fax
- (505) 662-4351
- NPI assigned
- Jul 12, 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 72160 | NM | Primary |
Addresses
Primary practice location
3917 West Rd
Suite 150
Los Alamos, NM 87544
Mailing address
3917 West Rd
Suite 150
Los Alamos, NM 87544
Phone (505) 662-4351
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18523 | Medicaid | NM |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72160 | NM | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208304000000",
"number": "1629076864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3917 WEST RD",
"address_2": "SUITE 150",
"city": "LOS ALAMOS",
"state": "NM",
"postal_code": "87544",
"telephone_number": "505-662-4351",
"fax_number": "505-662-4351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3917 WEST RD",
"address_2": "SUITE 150",
"city": "LOS ALAMOS",
"state": "NM",
"postal_code": "87544",
"telephone_number": "505-662-4351",
"fax_number": "505-662-4351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BILLY",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-12",
"last_updated": "2008-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NM",
"license": "72160",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "18523",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Alamos, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.