Active NPI
Samone J Jackson, OT
- Occupational Therapist
- Hoover, AL
National Provider Identifier
1679348874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4021
- Practice address
- 3075 John Hawkins Pkwy Ste N-O
Hoover, AL 35244-1085 - Phone
- (205) 202-0874
- Fax
- (205) 573-3709
- NPI assigned
- Nov 17, 2023
- Last updated
- Nov 17, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 4021 | AL | Primary |
Addresses
Primary practice location
3075 John Hawkins Pkwy Ste N-O
Hoover, AL 35244-1085
Mailing address
3075 John Hawkins Pkwy Ste N-O
Hoover, AL 35244-1085
Phone (205) 202-0874
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3075 John Hawkins Pkwy
Suite N O
Hoover, AL 35244-1085
Phone (205) 202-0874
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4021 | AL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Magic City Physical Therapy | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Birmingham, AL
- NPI 1912520115
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700179200000",
"number": "1679348874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3075 JOHN HAWKINS PKWY STE N-O",
"city": "HOOVER",
"state": "AL",
"postal_code": "352441085",
"telephone_number": "205-202-0874",
"fax_number": "205-573-3709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3075 JOHN HAWKINS PKWY STE N-O",
"city": "HOOVER",
"state": "AL",
"postal_code": "352441085",
"telephone_number": "205-202-0874",
"fax_number": "205-573-3709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SAMONE",
"middle_name": "J",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-17",
"last_updated": "2023-11-17",
"certification_date": "2023-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AL",
"license": "4021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hoover, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.