NPIMap

Organization Active NPI

Jackson Siegelbaum Gastroenterology LTD

  • Gastroenterology Physician
  • Camp Hill, PA
National Provider Identifier
1902866205
Registry record updated Oct 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
JACKSON SIEGELBAUM GASTROENTEROLOGY LTD
Practice address
423 N 21St St
Suite 100
Camp Hill, PA 17011-2207
Phone
(717) 761-0930
Fax
(717) 761-0465
NPI assigned
Mar 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2007

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

Authorized official

Name
Dr. Frank Wilson Jackson, MDNPI 1164421673
Title
President
Phone
(717) 761-0930

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

423 N 21St St
Suite 100
Camp Hill, PA 17011-2207

Mailing address

423 N 21St St
Suite 100
Camp Hill, PA 17011-2207
Phone (717) 761-0930

Other identifiers 1

IdentifierTypeStateIssuer
CM8555OtherPARAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040615000390 PA Part B Supplier - Clinic/Group Practice 5799769139 Receives reassigned benefits from 11 practitioners
Practice locations: Camp Hill, PA; Harrisburg, PA

National Provider Directory

National Provider Directory

Locations

423 N 21st St
Ste 100
Camp Hill, PA 17011
Phone (717) 525-6488

423 N 21st St
Ste 200
Camp Hill, PA 17011
Phone (717) 763-9880

4387 Sturbridge Dr
Ste 100
Harrisburg, PA 17110
Phone (717) 238-3111

4387 Sturbridge Dr
#1
Harrisburg, PA 17110

4387 Sturbridge Dr
Harrisburg, PA 17110
Phone (717) 238-3111

4387 Sturbridge Dr
Fl 1
Harrisburg, PA 17110

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DGCHDD

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1902866205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 N 21ST ST",
            "address_2": "SUITE 100",
            "city": "CAMP HILL",
            "state": "PA",
            "postal_code": "170112207",
            "telephone_number": "717-761-0930",
            "fax_number": "717-761-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 N 21ST ST",
            "address_2": "SUITE 100",
            "city": "CAMP HILL",
            "state": "PA",
            "postal_code": "170112207",
            "telephone_number": "717-761-0930",
            "fax_number": "717-761-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON SIEGELBAUM GASTROENTEROLOGY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "717-761-0930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CM8555",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camp Hill, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; 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.