Randy Alan Jackson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

N0854 Issued in TX

Practice address

2602 Saint Michael Dr
Suite 205
Texarkana, TX 75503-2387

Phone

(903) 614-5111

NPI assigned

May 27, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

HospitalistAlso: Internal Medicine

Education

University of Texas Medical School at Houston, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Texas Physician Services, PLLCGroup PAC ID 6305295429, 236 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Heritage Hospice of Texarkana LLC Hospice, Texarkana, TX, CCN 671646
• Christus St Michael Health System Hospital, Texarkana, TX, CCN 450801
• Christus St Michael Health System Inpatient rehabilitation facility, Texarkana, TX, CCN 45T801

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Heritage Hospice of Texarkana LLC

  • Community Based Hospice Care Agency
  • Texarkana, TX
  • NPI 1689842536

  Contracted Managing Employee

  CMS ownership

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.

• North Texas Physician Services, PLLC

  • Internal Medicine Physician
  • Longview, TX
  • NPI 1992586150
  Medicare reassignment Care Compare group NPD
• Cogent Healthcare of Texas, PA

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1992722953
  Medicare reassignment NPD
• Hospitalist Medicine Physicians of Texas, PLLC

  • Internal Medicine Physician
  • Humble, TX
  • NPI 1629307095
  Medicare reassignment NPD
• Christus Health Ark-la-Tex

  dba CHRISTUS St. Michael Health System

  • General Acute Care Hospital
  • Texarkana, TX
  • NPI 1295736734
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Christus Health Ark-la-Tex

  dba Christus St. Michael Health System

  • General Practice Physician
  • Texarkana, TX
  • NPI 1184623266

  Hospital

  Care Compare affiliation
• Christus Health Ark-la-Tex

  dba CHRISTUS St. Michael Health System

  • General Acute Care Hospital
  • Texarkana, TX
  • NPI 1295736734
  Care Compare affiliation
• Christus Health Ark-la-Tex

  dba CHRISTUS St Michael Rehabilitation Hospital

  • Rehabilitation Hospital Unit
  • Texarkana, TX
  • NPI 1467453902

  Inpatient rehabilitation facility

  Care Compare affiliation
• Heritage Hospice of Texarkana LLC

  • Community Based Hospice Care Agency
  • Texarkana, TX
  • NPI 1689842536
  Care Compare affiliation

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243296000000",
    "number": "1689832768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7203 BRINGLE RDG",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755035460",
            "telephone_number": "903-306-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2602 SAINT MICHAEL DR",
            "address_2": "SUITE 205",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032387",
            "telephone_number": "903-614-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RANDY",
        "middle_name": "ALAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-27",
        "last_updated": "2009-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N0854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200544901",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "8BU284",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176329001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200235880 A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lacey Jackson Teer
• Don Jackson, O.D.
• Gary L Jackson, CRNA
• Juliet Noelle Jackson
• Noel R Jackson, CRNA
• Job Jacob, M.D.
• Elizabeth Jean Jacobsen, FNP-C
• Erik Jacobsen, MD
• Jacqueline S O'Donald, M.D., PA
• James M Hurley MD PA (Texarkana Cardiology Associates)

• Internal Medicine Physician in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• 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.

Verify at the official NPI Registry.