Active NPI
David A Jackson, PHD
- Psychologist
- Grand Forks, ND
National Provider Identifier
1801853775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 359
- Practice address
- 3535 S 31St St Ste 201
Grand Forks, ND 58201-3593 - Phone
- (701) 780-6821
- Fax
- (701) 780-1973
- NPI assigned
- Apr 26, 2006
- Last updated
- Sep 7, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 359 | ND | Primary |
Addresses
Primary practice location
3535 S 31St St Ste 201
Grand Forks, ND 58201-3593
Mailing address
3535 S 31St St Ste 201
Grand Forks, ND 58201-3593
Phone (701) 780-6821
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22269 | Other | ND | ND BC/BS |
| 12028 | Medicaid | ND | |
| 169230500 | Medicaid | MN | |
| 65F61JA | Other | MN | MN BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 359 | ND | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Psychiatric Care | Psychologist | Past | Accepting new patients |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Critical Access Hospital
- Glasgow, MT
- NPI 1689685323
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536278400000",
"number": "1801853775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3535 S 31ST ST STE 201",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582013593",
"telephone_number": "701-780-6821",
"fax_number": "701-780-1973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 S 31ST ST STE 201",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582013593",
"telephone_number": "701-780-6821",
"fax_number": "701-780-1973"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DAVID",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-26",
"last_updated": "2018-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ND",
"license": "359",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ND BC/BS",
"identifier": "22269",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "12028",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "169230500",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN BC/BS",
"identifier": "65F61JA",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.