NPIMap

Organization Active NPI

Jackson Physician Corp

  • General Practice Physician
  • Jackson, KY
National Provider Identifier
1841234671
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
JACKSON PHYSICIAN CORP
Practice address
424 Jett Dr
Jackson, KY 41339-9621
Phone
(066) 936-4830
NPI assigned
Jun 15, 2006
Last updated
Nov 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Authorized official

Name
Laura J Fey
Title
Sr. Director Physician Rev Cycle
Phone
(615) 221-3641

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X
Nurse Practitioner 363L00000X
Family Nurse Practitioner 363LF0000X
Certified Registered Nurse Anesthetist 367500000X
Internal Medicine Physician 207R00000X
Cardiovascular Disease Physician 207RC0000X
Obstetrics & Gynecology Physician 207V00000X
General Practice Physician 208D00000X Primary
Foot & Ankle Surgery Podiatrist 213ES0103X

Addresses

Primary practice location

424 Jett Dr
Jackson, KY 41339-9621

Mailing address

PO Box 5009
Brentwood, TN 37024-5009
Phone (615) 221-3641

Other identifiers 1

IdentifierTypeStateIssuer
65930364MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040514000238 KY Part B Supplier - Clinic/Group Practice 9436149275 Receives reassigned benefits from 14 practitioners
Practice locations: Paintsville, KY; Richmond, KY; Jackson, KY; Hazard, KY; Campton, KY; Beattyville, KY

National Provider Directory

National Provider Directory
Tax ID family
Booneville Medical Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1550 Highway 15 S
#27
Jackson, KY 41339
Phone (606) 693-0116

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1841234671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5009",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370245009",
            "telephone_number": "615-221-3641",
            "fax_number": "615-221-1484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 JETT DR",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413399621",
            "telephone_number": "066-936-4830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PHYSICIAN CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "FEY",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SR. DIRECTOR PHYSICIAN REV CYCLE",
        "authorized_official_telephone_number": "615-221-3641"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65930364",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.