John Claude Jackson, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1672 Issued in OK

Practice address

410 E Cherokee St
Wagoner, OK 74467-4708

Phone

(918) 485-5591

Fax

(918) 485-5758

NPI assigned

Mar 30, 2006

Sex

Male

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

Other names 1

• Michael Douglas Gorman Other name

Medicare fee-for-service enrollment

Enrolled in OK

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Allied Home Health Services, Inc.

  • Home Health Agency
  • Tulsa, OK
  • NPI 1427019710
  NPD (past)

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490227200000",
    "number": "1669433546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 E CHEROKEE ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674708",
            "telephone_number": "918-485-5591",
            "fax_number": "918-485-5758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E CHEROKEE ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674708",
            "telephone_number": "918-485-5591",
            "fax_number": "918-485-5758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOHN",
        "middle_name": "CLAUDE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2017-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "1672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100141080C",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100141080E",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "GORMAN",
            "middle_name": "DOUGLAS",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jordan Hurst
• Michael Dean Hutchings
• Kyla Nicole Ibarra, PTA
• J & a Family Medicine, LLC
• Jackson Medical Clinic, PC
• Kim Marie Jackson
• Maeghan Lee Jakubovitz
• Teresa Melinda James, APRN CFNP
• Jeff S. Jennings, DO, PLLC
• Pamela Sue Jennings

• Family Medicine Physician in Wagoner, OK
• Providers in Wagoner, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.