Keith Jackson

Primary specialty

DentistTaxonomy code 122300000X

License

30023286 Issued in OH

Practice address

7113 Miami Ave
Madeira, OH 45243-2616

Phone

(513) 561-5318

Fax

(513) 561-1120

NPI assigned

Aug 12, 2010

Last updated

Aug 12, 2010By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dr. William G. Jackson Jr. DDS Inc

  • Dentist
  • Cincinnati, OH
  • NPI 1033214846
  NPD (past)

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281571200000",
    "number": "1831404938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7113 MIAMI AVE",
            "city": "MADEIRA",
            "state": "OH",
            "postal_code": "452432616",
            "telephone_number": "513-561-5318",
            "fax_number": "513-561-1120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7113 MIAMI AVE",
            "city": "MADEIRA",
            "state": "OH",
            "postal_code": "452432616",
            "telephone_number": "513-561-5318",
            "fax_number": "513-561-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KEITH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-12",
        "last_updated": "2010-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30023286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katelyn Fleischman, O.D.
• Christie Leigh Francia, O.D.
• Mary Gallenstein
• Heartland of Madeira Oh LLC (Heartland of Madeira)
• Frederick A Heiselman, DDS
• William Jackson
• Kroger Limited Partnership I (Kroger Pharmacy)
• Robert M Letscher, MD
• Madeira City School District
• Madeira Healthcare LLC

• Dentist in Madeira, OH
• Providers in Madeira, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.