NPIMap

Individual provider Active NPI

Eli O. Jackson, D.M.D.

  • General Practice Dentistry
  • Bowling Green, KY
National Provider Identifier
1710959218
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5450 Issued in KY
Practice address
727 U.S. 31 W by Pass
Suite 102B
Bowling Green, KY 42101-4999
Phone
(270) 781-2952
Fax
(270) 793-0977
NPI assigned
Feb 7, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5450 KY Primary

Addresses

Primary practice location

727 U.S. 31 W by Pass
Suite 102B
Bowling Green, KY 42101-4999

Mailing address

727 U.S. 31 W by Pass
Suite 102B
Bowling Green, KY 42101-4999
Phone (270) 781-2952

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130628000769 KY Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2264672955

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5450KYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Health Corporation, Inc. PastSince Jun 1, 1997 Accepting new patients
Eli Jackson III PSC PastSince Apr 15, 2006 Accepting new patients
Bowling Green-Warren County Community Hospital Corporation PastSince Jan 1, 2000 Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 19

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

FacilityTypeRoleSince
The Medical Center at ScottsvilleScottsville, KY, CCN 181324 Hospital Corporate Director Jan 1, 2000
The Medical CenterBowling Green, KY, CCN 180013 Hospital Corporate Director Jan 1, 2000
The Medical Center at ScottsvilleScottsville, KY, CCN 18Z324 Hospital Corporate Director Jan 1, 2000
The Medical Center at CavernaHorse Cave, KY, CCN 181314 Hospital Corporate Director Jan 1, 2000
The Medical Center at CavernaHorse Cave, KY, CCN 18Z314 Hospital Corporate Director Jan 1, 2000
The Medical Center at AlbanyAlbany, KY, CCN 181333 Hospital Corporate Director Jan 1, 2000
The Medical Center at FranklinFranklin, KY, CCN 181318 Hospital Corporate Director Jan 1, 2000
The Medical Center at AlbanyAlbany, KY, CCN 18Z333 Hospital Corporate Director Jan 1, 2000
The Medical Center at FranklinFranklin, KY, CCN 18Z318 Hospital Corporate Director Jan 1, 2000
The Medical Center at RussellvilleRussellville, KY, CCN 180066 Hospital Corporate Director Jul 1, 2024
The Medical Center at RussellvilleRussellville, KY, CCN 18U066 Hospital Corporate Director Jul 1, 2024
Cal Turner Rehab and Specialty CareScottsville, KY, CCN 185325 Skilled nursing facility Corporate Director Jan 1, 2000
The Medical Center Home Care ProgramBowling Green, KY, CCN 187044 Home health agency Corporate Director Jan 1, 2000
Med Center Health Primary Care ScottsvilleScottsville, KY, CCN 183458 Rural health clinic Corporate Director Jan 1, 2000
Med Center Health Primary Care MunfordvilleMunfordville, KY, CCN 183465 Rural health clinic Corporate Director Jan 1, 2000
Med Center Health Primary Care CavernaHorse Cave, KY, CCN 183464 Rural health clinic Corporate Director Jan 1, 2000
Med Center Health Primary Care FranklinFranklin, KY, CCN 188530 Rural health clinic Corporate Director Jan 1, 2000
Med Center Health Primary Care AuburnAuburn, KY, CCN 188929 Rural health clinic Corporate Director Jul 1, 2024
Med Center Health Primary Care RussellvilleRussellville, KY, CCN B03937 Rural health clinic Corporate Director Jul 1, 2024

Owned or controlled facilities with NPI records 19

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

View all 19

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1710959218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "727 U.S. 31 W BY PASS",
            "address_2": "SUITE 102B",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421014999",
            "telephone_number": "270-781-2952",
            "fax_number": "270-793-0977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 U.S. 31 W BY PASS",
            "address_2": "SUITE 102B",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421014999",
            "telephone_number": "270-781-2952",
            "fax_number": "270-793-0977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ELI",
        "middle_name": "O.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "5450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.