Hershel C Jackson MD PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

AJ043930 Issued in MI

Legal business name

HERSHEL C JACKSON MD PC

Practice address

23077 Greenfield Rd
#450
Southfield, MI 48075

Phone

(248) 599-8810

NPI assigned

Jul 24, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Hershel Clark Jackson, MDNPI 1023153178

Title

Medical Doctor

Phone

(248) 559-8810

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hershel Jackson, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Detroit, MI
  • NPI 1023153178
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412121600000",
    "number": "1659536076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23077 GREENFIELD RD",
            "address_2": "#450",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "248-599-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23077 GREENFIELD RD",
            "address_2": "#450",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "248-599-8810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERSHEL C JACKSON MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-24",
        "last_updated": "2014-10-01",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "HERSHEL",
        "authorized_official_middle_name": "CLARK",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "248-559-8810",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "AJ043930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "0635321",
            "identifier": "BC BS",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287072310",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keith James Herriman, LLP
• Roya Herrle, LLBSW
• T'Melia Stephanie Herron
• Tonya Rashawnn Herron, MSW
• Barry Herschman, MD
• Hershman Chiropractic & Rehab PLLC
• Hershman Rehab LLC
• Hershman Sports & Spine PLLC
• Kathryn Hess, PEER SPECIALIST
• Katilyn Hess, PA

• Internal Medicine Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; 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.