Michael Doniel Jackson, M.D

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

37998 Issued in MN

Practice address

205 Wabasha St S
Saint Paul, MN 55107-1805

Phone

(952) 967-5584

NPI assigned

Apr 25, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA, MN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physical Medicine and Rehabilitation

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Group Health, Inc.

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1710924683
  Medicare reassignment Care Compare group NPD
• Regenerative Medicine of Iowa PC

  • Physical Medicine & Rehabilitation Physician
  • West Des Moines, IA
  • NPI 1346966587
  Medicare reassignment NPD Authorized official
• Group Health, Inc.

  • Pain Clinic/Center
  • Anoka, MN
  • NPI 1689068462
  NPD
• Group Health, Inc.

  • General Practice Dentistry
  • Saint Paul, MN
  • NPI 1952042053
  NPD
• Boone County Hospital

  • Critical Access Hospital
  • Boone, IA
  • NPI 1467434225
  NPD (past)
• Floyd County Memorial Hospital Commission

  • Critical Access Hospital
  • Charles City, IA
  • NPI 1265402390
  NPD (past)

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1659590735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 WESTOWN PKWY STE 200",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502661332",
            "telephone_number": "515-223-7773",
            "fax_number": "402-939-0407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 WABASHA ST S",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551071805",
            "telephone_number": "952-967-5584"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2910 Westown Pkwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "West Des Moines",
            "state": "IA",
            "postal_code": "502661332",
            "country_code": "US",
            "telephone_number": "515-223-7773",
            "fax_number": "402-939-0407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHAEL",
        "middle_name": "DONIEL",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IA",
            "license": "37062",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "37998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "IN PROCESS",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kassidy Jackson
• Kathleen Adele Jackson, AG-ACNP
• Kristina Jackson, LPCC
• Leah Jackson
• Melissa Jackson, RN
• Paige Taylor Aubriana Jackson, RN
• Steven Bruce Jackson, D.C, D.A.B.C.O
• Annette L Jacob, LICSW
• Therese Jacobs-Stewart, MA, LP
• Delle Marian Jacobs, MSW, LICSW, LMFT

• Physical Medicine & Rehabilitation Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Physical Medicine & Rehabilitation Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.