Tara Naomi Jackson, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2021028685 Issued in MO

Practice address

1137 Independence Dr
West Plains, MO 65775-4221

Phone

(417) 255-8464

NPI assigned

May 8, 2018

Last updated

Aug 4, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Family Practice

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rural Alliance for Better Family HealthGroup PAC ID 6103734058, 8 clinicians

Tri-County Family Practice, LLCGroup PAC ID 5294769238, 9 clinicians

Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Lukes Hospital Hospital, Chesterfield, MO, CCN 260179
• Ozarks Healthcare Hospital, West Plains, MO, CCN 260078

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Rural Alliance for Better Family Health

  dba Southern Missouri Community Health Center

  • Federally Qualified Health Center (FQHC)
  • West Plains, MO
  • NPI 1144280132
  Medicare reassignment Care Compare group NPD
• Tri-County Family Practice, LLC

  • Family Medicine Physician
  • O'Fallon, MO
  • NPI 1285720169
  Medicare reassignment Care Compare group NPD
• Aging Well Health Care, LLC

  • Home Health Agency
  • Saint Louis, MO
  • NPI 1215936588
  Care Compare group
• Rural Alliance for Better Family Health

  dba Oregon County Community Health Center

  • General Practice Dentistry
  • Thayer, MO
  • NPI 1730414178
  NPD
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641

  Family Medicine

  NPD (past)
• Rural Alliance for Better Family Health

  dba Southern Missouri Community Health Center Thayer Clinic

  • Federally Qualified Health Center (FQHC)
  • Thayer, MO
  • NPI 1164488680
  NPD (past)

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

• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  Care Compare affiliation
• St. Lukes Episcopal-Presbyterian Hospital

  dba St. Luke's Hospital

  • General Acute Care Hospital
  • Chesterfield, MO
  • NPI 1346251543
  Care Compare affiliation

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

{
    "created_epoch": "1525737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1770072332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 INDEPENDENCE DR",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657754221",
            "telephone_number": "417-255-8464",
            "fax_number": "405-231-3037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1137 INDEPENDENCE DR",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657754221",
            "telephone_number": "417-255-8464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TARA",
        "middle_name": "NAOMI",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-08",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2021028685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phool Iqbal
• Brian Lee Israel, MD
• Sathish Kumar Itikyala, M.D.
• Brittany Jackson, LPN
• Christy Lynn Jackson, LPC
• Ashley Jacobson
• James Scott Wiley
• Sydney Jennings, COTA/L
• Edward Teddy Jeter
• Karen Johal

• Family Medicine Physician in West Plains, MO
• Providers in West Plains, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.