Roger P Jackson, M.D.

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

R5717 Issued in MO

Practice address

2750 Clay Edwards Dr Ste 600
North Kansas City, MO 64116-3258

Phone

(816) 471-6611

Fax

(816) 471-6192

NPI assigned

Jan 4, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1811044548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 CLAY EDWARDS DR STE 600",
            "city": "NORTH KANSAS CITY",
            "state": "MO",
            "postal_code": "641163258",
            "telephone_number": "816-471-6611",
            "fax_number": "816-471-6192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 CLAY EDWARDS DR STE 600",
            "city": "NORTH KANSAS CITY",
            "state": "MO",
            "postal_code": "641163258",
            "telephone_number": "816-471-6611",
            "fax_number": "816-471-6192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROGER",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "MO",
            "license": "R5717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KC",
            "identifier": "07979011",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "200018411",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "09-00221",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4571391",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dean Ibrahim, MD
• Katelyn Rose Ingram
• Jennah Ann Irsik, AGACNP-BC
• Kelly Rae Isabell, PTA
• Emad F Israel, MD
• Kristen Ayana Jacobs, MD
• James S. Zarr, MD, PC
• Jeff Laferla Vision Institute, OD PC
• Alison Johnson, RN, BSN, MSN, NP-C
• Kendall Johnson, D.O.

• Orthopaedic Surgery of the Spine Physician in North Kansas City, MO
• Providers in North Kansas City, MO by specialty
• Orthopaedic Surgery of the Spine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.