Active NPI
Christopher Jackson, MD
- Surgery Physician
- Portland, OR
National Provider Identifier
1669429700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD166621
- Practice address
- 10000 SE Main St
Ste 316
Portland, OR 97216-2448 - Phone
- (503) 256-1575
- Fax
- (503) 253-9848
- NPI assigned
- May 27, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD00019884 | WA | |
| Surgery Physician | 208600000X | MD166621 | OR | Primary |
Addresses
Primary practice location
10000 SE Main St
Ste 316
Portland, OR 97216-2448
Mailing address
10000 SE Main St
Ste 316
Portland, OR 97216-2448
Phone (503) 256-1575
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8539900 | Medicaid | WA |
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 |
|---|---|---|---|
| MD166621 | OR | MD | Surgery Physician |
| MD00019884 | WA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428451200000",
"number": "1669429700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10000 SE MAIN ST",
"address_2": "STE 316",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972162448",
"telephone_number": "503-256-1575",
"fax_number": "503-253-9848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10000 SE MAIN ST",
"address_2": "STE 316",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972162448",
"telephone_number": "503-256-1575",
"fax_number": "503-253-9848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CHRISTOPHER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-27",
"last_updated": "2015-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WA",
"license": "MD00019884",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OR",
"license": "MD166621",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8539900",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.