Alfred Vaughn D Jackson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

31351 Issued in CO

Practice address

416 Main Street
La Jara, CO 81140-0272

Phone

(719) 274-4500

Fax

(719) 274-4504

NPI assigned

May 15, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384300800000",
    "number": "1891746707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 272",
            "address_2": "416 MAIN STREET",
            "city": "LA JARA",
            "state": "CO",
            "postal_code": "811400272",
            "telephone_number": "719-274-4500",
            "fax_number": "719-274-4504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 MAIN STREET",
            "city": "LA JARA",
            "state": "CO",
            "postal_code": "811400272",
            "telephone_number": "719-274-4500",
            "fax_number": "719-274-4504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALFRED VAUGHN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2013-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "1823241205",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "89132",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "31351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01313519",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89132",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Healthone Clinic Services-Surgical Specialties LLC
• Healthone Heart Care LLC
• Colin James Henderson, MD
• Grant Allen Hurley, MD
• Innova Emergency Medical Associates PC
• Brian Gene Jackson, PAC
• Maria Virginia Jordan, FNP
• Elizabeth B Kinney, MD
• La Jara Pharmaceutical Center, Inc.
• Linda Lee I, FNP, PA

• Family Medicine Physician in La Jara, CO
• Providers in La Jara, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; 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.