Active NPI
Dawn M Jackson, MD
- Family Medicine Physician
- Kansas City, MO
National Provider Identifier
1629330790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2012017896
- Practice address
- 6675 Holmes Rd
Suite 450
Kansas City, MO 64131-1150 - Phone
- (816) 276-7600
- NPI assigned
- Jun 13, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2012017896 | MO | Primary |
Addresses
Primary practice location
6675 Holmes Rd
Suite 450
Kansas City, MO 64131-1150
Mailing address
9658 W 117TH St
Overland Park, KS 66210-3134
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 |
|---|---|---|---|
| 2012017896 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Goppert - Trinity Family Care, LLC | Family 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.
-
- Family Medicine Physician
- Kansas City, MO
- NPI 1922097013
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339545600000",
"number": "1629330790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9658 W 117TH ST",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662103134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6675 HOLMES RD",
"address_2": "SUITE 450",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641311150",
"telephone_number": "816-276-7600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DAWN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-13",
"last_updated": "2012-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "2012017896",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.