Active NPI
Robert Terrell Jackson, DIABETES LS COACH
- Counselor
- Corona, CA
National Provider Identifier
1851865034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 650 S Main St
Corona, CA 92882-3417 - Phone
- (951) 642-0341
- NPI assigned
- Jan 21, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
650 S Main St
Corona, CA 92882-3417
Mailing address
PO Box 821
Artesia, CA 90702-0821
Phone (951) 642-0341
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558583427 | Other | CA | RD,CDE IN THE PROCESS OF REAPPLYING FOR MEDICARE |
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| People Providing Training Solutions | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Registered Dietitian
- Corona, CA
- NPI 1477116341
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548028800000",
"number": "1851865034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 821",
"city": "ARTESIA",
"state": "CA",
"postal_code": "907020821",
"telephone_number": "951-642-0341",
"fax_number": "951-736-6401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 S MAIN ST",
"city": "CORONA",
"state": "CA",
"postal_code": "928823417",
"telephone_number": "951-642-0341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ROBERT",
"middle_name": "TERRELL",
"credential": "DIABETES LS COACH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-21",
"last_updated": "2019-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RD,CDE IN THE PROCESS OF REAPPLYING FOR MEDICARE",
"identifier": "1558583427",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.