NPIMap

Individual provider Active NPI

Anthony D Jackson, M.D.

  • Obstetrics & Gynecology Physician
  • Oklahoma City, OK
National Provider Identifier
1750333944
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
20399 Issued in OK
Practice address
1140 SW 44TH St
Oklahoma City, OK 73109-3602
Phone
(405) 632-1730
Fax
(405) 632-2640
NPI assigned
May 16, 2006
Last updated
Jun 18, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 20399 OK Primary

Addresses

Primary practice location

1140 SW 44TH St
Oklahoma City, OK 73109-3602

Mailing address

1140 SW 44TH St
Oklahoma City, OK 73109-3602
Phone (405) 632-1730

Other identifiers 1

IdentifierTypeStateIssuer
100131710AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20070808000076 OK Practitioner - Obstetrics/Gynecology 1052402898 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Oklahoma College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
OB GYN Associates LLCGroup PAC ID 9537250378, 2 clinicians

Practice addresses (Care Compare)

6501 S Western Ave
Suite 101
Oklahoma City, OK 73139-2011
Phone (405) 632-1730

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20399OKMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
OB GYN Associates LLC Obstetrics & Gynecology CurrentSince Jul 1, 2007 Accepting new patients
Surgical Hospital of Oklahoma LLC Past Accepting new patients
Integris South Oklahoma City Hospital Corporation Past Accepting new patients
Integris Baptist Medical Center Inc Past Accepting new patients

Locations

1140 SW 44th St
Oklahoma City, OK 73109
Phone (405) 632-1730

4401 S Western Ave
Oklahoma City, OK 73109
Phone (405) 636-7000

6501 S Western Ave
Ste 101
Oklahoma City, OK 73139

Interoperability endpoints

  • Direct secure messaging: adjackso@yourcarecommunity.org

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Surgical Hospital of OklahomaOklahoma City, OK, CCN 370201 Hospital Limited Partnership Interest (0.79%) Jul 29, 2013
Integris Southwest Medical CenterOklahoma City, OK, CCN 370106 Hospital Corporate Director Jul 1, 2014
Integris Jim Thorpe Inpatient RehabilitationOklahoma City, OK, CCN 37T106 Hospital Corporate Director Jul 1, 2014

Owned or controlled facilities with NPI records 4

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

Organizations & group practices 4

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213747200000",
    "number": "1750333944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 SW 44TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093602",
            "telephone_number": "405-632-1730",
            "fax_number": "405-632-2640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 SW 44TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093602",
            "telephone_number": "405-632-1730",
            "fax_number": "405-632-2640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANTHONY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2008-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OK",
            "license": "20399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100131710A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.