Active NPI
David L. Jackson, M.D., PSC
- Physical Medicine & Rehabilitation Physician
- Lexington, KY
National Provider Identifier
1811995996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 24005
- Legal business name
- DAVID L. JACKSON, M.D., PSC
- Practice address
- 2050 Versailles Rd
Lexington, KY 40504-1405 - Phone
- (859) 367-7110
- Fax
- (859) 367-7138
- NPI assigned
- Jul 12, 2005
- Last updated
- Feb 3, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David L. Jackson, M.D.
- Title
- President
- Phone
- (859) 367-7110
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 24005 | KY | Primary |
Addresses
Primary practice location
2050 Versailles Rd
Lexington, KY 40504-1405
Mailing address
2050 Versailles Rd
Lexington, KY 40504-1405
Phone (859) 367-7110
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65925463 | Medicaid | KY | |
| C66084 | Other | KY | BLUEGRASS FAMILY HEALTH |
| 2300002 | Other | KY | UNITED HEALTHCARE PIN |
| 000000050829 | Other | KY | ANTHEM B/C & B/S PIN |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121126400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1233619200000",
"number": "1811995996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050 VERSAILLES RD",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405041405",
"telephone_number": "859-367-7110",
"fax_number": "859-367-7138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050 VERSAILLES RD",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405041405",
"telephone_number": "859-367-7110",
"fax_number": "859-367-7138"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DAVID L. JACKSON, M.D., PSC",
"organizational_subpart": "NO",
"enumeration_date": "2005-07-12",
"last_updated": "2009-02-03",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "L.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "859-367-7110",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "KY",
"license": "24005",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "65925463",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUEGRASS FAMILY HEALTH",
"identifier": "C66084",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE PIN",
"identifier": "2300002",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM B/C & B/S PIN",
"identifier": "000000050829",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
- Robert Alan Davenport, M.D.
- Ryan Tierra Davenport, LPCA
- William Patrick Davey, M.D.
- David B Cassidy, MD, PLLC
- David Feinberg (Feinberg & Associates)
- David L. Wells II DMD MD PLLC
- David M. Blake MD PSC
- David R. Kelly, M.D., P.S.C.
- David S. Kirn, M.D., P.L.L.C.
- David T. Monson DMD PSC (Monson Family Dentistry)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.