Individual provider Active NPI

Ryan Scott Jackson, MD

  • Otolaryngology Physician
  • Saint Louis, MO
National Provider Identifier
1710114582
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
2015010898 Issued in MO
Practice address
4921 Parkview PL
Dept Otolaryngology, Ste 11a
Saint Louis, MO 63110-1032
Phone
(314) 362-7509
Fax
(314) 362-7522
NPI assigned
Jun 18, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 2015010898 MO Primary

Addresses

Primary practice location

4921 Parkview PL
Dept Otolaryngology, Ste 11a
Saint Louis, MO 63110-1032

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-7509

Other identifiers 1

IdentifierTypeStateIssuer
200022003MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20150727001562 MO Practitioner - Otolaryngology 5799900346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
St. Louis College of Physicians and Surgeons, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

4921 Parkview PL
Suite 11a
Saint Louis, MO 63110-1032
Phone (314) 362-7509

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2015010898MOMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Jul 1, 2015 Accepting new patients
Washington University CurrentSince Jul 1, 2015 Accepting new patients
Ozarks Medical Center Otolaryngology Past Accepting new patients
Washington University Past Accepting new patients
Barnes Jewish Hospital Past Accepting new patients

Locations

4500 Forest Park Ave
Fl 5
Saint Louis, MO 63108

1 Barnes Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-9170

660 S Euclid Ave
#8115
Saint Louis, MO 63110
Phone (314) 362-7395

4921 Parkview Pl
Ste 11A
Saint Louis, MO 63110
Phone (314) 362-7489

1044 N Mason Rd
Ste L20
Saint Louis, MO 63141
Phone (314) 996-3800

Interoperability endpoints

  • Direct secure messaging: rjackson157752@direct.carenet.org
  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1710114582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-7509",
            "fax_number": "314-362-7522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 PARKVIEW PL",
            "address_2": "DEPT OTOLARYNGOLOGY, STE 11A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101032",
            "telephone_number": "314-362-7509",
            "fax_number": "314-362-7522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RYAN",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-18",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MO",
            "license": "2015010898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200022003",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4921 Parkview Pl",
            "address_2": "Dept Otolaryngology, Ste 11A",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.