Leslie K Jackson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036072876 Issued in IL

Practice address

404 E Main Cross St
Taylorville, IL 62568-2656

Phone

(217) 824-3758

Fax

(217) 824-3758

NPI assigned

Jan 11, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Leslie Jackson, MD

  • Family Medicine Physician
  • Taylorville, IL
  • NPI 1386821502
  NPD (past) Authorized official

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271116800000",
    "number": "1649320904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 E MAIN CROSS ST",
            "address_2": "P O BOX 318",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "625682656",
            "telephone_number": "217-824-3758",
            "fax_number": "217-824-3758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 E MAIN CROSS ST",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "625682656",
            "telephone_number": "217-824-3758",
            "fax_number": "217-824-3758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LESLIE",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2010-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036072876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371403688001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036072876",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• HSHS Medical Group Inc
• Hugo H Orlandini Jr
• Robert Charles Huss, DDS
• Lawrence Timothy Hutson, M.D.
• Natalie Rae Inman, BA, CADC
• John L Kain, DC
• Lynn Marie Kink, M.D.
• Haley Klein
• Gerry A Klinefelter, RN, FNP
• Karen A Koenig, NP

• Family Medicine Physician in Taylorville, IL
• Providers in Taylorville, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.