Active NPI
Thad Jackson
- Counselor
- Baton Rouge, LA
National Provider Identifier
1669988879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 449 Ben Hur Rd Apt 5106B
Baton Rouge, LA 70820-4144 - Phone
- (504) 410-1976
- NPI assigned
- Dec 26, 2017
- 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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
449 Ben Hur Rd Apt 5106B
Baton Rouge, LA 70820-4144
Mailing address
449 Ben Hur Rd Apt 5106B
Baton Rouge, LA 70820-4144
Phone (504) 410-1976
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000 | Medicaid | LA |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1514246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1669988879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "449 BEN HUR RD APT 5106B",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708204144",
"telephone_number": "504-410-1976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "449 BEN HUR RD APT 5106B",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708204144",
"telephone_number": "504-410-1976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "THAD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-26",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00000",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.