Active NPI
Robert C Jackson, MD
- Orthopaedic Surgery Physician
- Knoxville, TN
National Provider Identifier
1861472532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 8261
- Practice address
- 9430 Park West Blvd
Suite 130
Knoxville, TN 37923-4200 - Phone
- (865) 690-4861
- Fax
- (865) 560-8525
- NPI assigned
- Jan 19, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 8261 | TN | Primary |
Addresses
Primary practice location
9430 Park West Blvd
Suite 130
Knoxville, TN 37923-4200
Mailing address
PO Box 32569
Knoxville, TN 37930-2569
Phone (865) 694-0062
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3163995 | Medicaid | TN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8261 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412121600000",
"number": "1861472532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 32569",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379302569",
"telephone_number": "865-694-0062",
"fax_number": "865-694-7907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9430 PARK WEST BLVD",
"address_2": "SUITE 130",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379234200",
"telephone_number": "865-690-4861",
"fax_number": "865-560-8525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ROBERT",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-19",
"last_updated": "2014-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "TN",
"license": "8261",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3163995",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.