Active NPI
Henry A Jackson, M.D.
- Pulmonary Disease Physician
- Metairie, LA
National Provider Identifier
1679549836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- L010098
- Practice address
- 4224 Houma Blvd Ste 380
Metairie, LA 70006-2980 - Phone
- (504) 454-5213
- Fax
- (504) 456-8053
- NPI assigned
- Feb 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | L010098 | LA | Primary |
Addresses
Primary practice location
4224 Houma Blvd Ste 380
Metairie, LA 70006-2980
Mailing address
4224 Houma Blvd 380
Ej Pulmonary Medicine Ejpulm
Metairie, LA 70006-2980
Phone (504) 454-5213
Other practice location 1
4320 Houma Blvd Fl 5
Metairie, LA 70006-2961
Phone (504) 454-5213
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1129054 | 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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L010098 | LA | MD | Pulmonary Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569196800000",
"number": "1679549836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4224 HOUMA BLVD 380",
"address_2": "EJ PULMONARY MEDICINE EJPULM",
"city": "METAIRIE",
"state": "LA",
"postal_code": "700062980",
"telephone_number": "504-454-5213",
"fax_number": "504-456-8053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4224 HOUMA BLVD STE 380",
"city": "METAIRIE",
"state": "LA",
"postal_code": "700062980",
"telephone_number": "504-454-5213",
"fax_number": "504-456-8053"
}
],
"practiceLocations": [
{
"address_1": "4320 Houma Blvd Fl 5",
"address_purpose": "LOCATION",
"city": "Metairie",
"state": "LA",
"postal_code": "700062961",
"country_code": "US",
"telephone_number": "504-454-5213",
"fax_number": "504-456-8053",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "HENRY",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-27",
"last_updated": "2019-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "LA",
"license": "L010098",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1129054",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Metairie, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.