Paula Jean Jackson, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

01059309A Issued in IN

Practice address

Bayne-Jones Army Community Hospital
1585 Third Street
Fort Polk, LA 71459

Phone

(337) 531-3276

NPI assigned

Aug 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Halethorpe, MD
  • NPI 1043378656
  NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  dba Abingdon Medical Center

  • Health Maintenance Organization
  • Abingdon, MD
  • NPI 1265971873
  NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  dba Kaiser Permanente Shady Grove Peritoneal Dialysis Facility

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
  • NPI 1962108753
  NPD

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1871504324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4132 LARSON LN",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217714512",
            "telephone_number": "301-829-9452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BAYNE-JONES ARMY COMMUNITY HOSPITAL",
            "address_2": "1585 THIRD STREET",
            "city": "FORT POLK",
            "state": "LA",
            "postal_code": "71459",
            "telephone_number": "337-531-3276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PAULA",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01059309A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "Bayne-Jones Army Community Hospital",
            "address_2": "1585 Third Street",
            "city": "Fort Polk",
            "state": "LA",
            "country_code": "US",
            "postal_code": "71459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alex Hradek, DDS
• Christopher Brian Hunt, PA
• Travis Husser, CRNA
• Ibrahim Idoh, DENTAL HYGIENE
• Isaac Aziz Isaiah, MD.
• Zachary Jacob Jackson
• Antqualene Lavette Johnson, PA-C
• Henry Johnson Jr., PA-C
• Jerri Lea Johnson, LCSW
• Nichelle Antoinette Johnson, R.D, L.D.

• Otolaryngology Physician in Fort Polk, LA
• Providers in Fort Polk, LA by specialty
• Otolaryngology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; 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.