NPIMap

Organization Active NPI

Jackson Pediatric Associates, LLC

Doing business as Jackson Pediatrics

  • Pediatrics Physician
  • Jackson, WY
National Provider Identifier
1912335530
Registry record updated Oct 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
JACKSON PEDIATRIC ASSOCIATES, LLC
Doing business as
Jackson Pediatrics
Practice address
557 E Broadway Ave
Jackson, WY 83001-8640
Phone
(307) 733-4627
Fax
(307) 733-5184
NPI assigned
Oct 16, 2013
Last updated
Oct 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2013

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

Authorized official

Name
Dr. Travis John Riddell, M.D.NPI 1720255128
Title
Pediatrician
Phone
(307) 733-4627

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

557 E Broadway Ave
Jackson, WY 83001-8640

Mailing address

PO Box 1029
Jackson, WY 83001-1029
Phone (307) 733-4627

Other names 1

  • Jackson Pediatrics Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381881600000",
    "number": "1912335530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1029",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830011029",
            "telephone_number": "307-733-4627",
            "fax_number": "307-733-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-733-4627",
            "fax_number": "307-733-5184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PEDIATRIC ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2013-10-16",
        "status": "A",
        "authorized_official_last_name": "RIDDELL",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "307-733-4627",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.