NPIMap

Organization Active NPI

Jackson Center

Doing business as The Jackson Center for Mental Wellness

  • Psychiatric/Mental Health Nurse Practitioner
  • Birmingham, AL
National Provider Identifier
1912645623
Registry record updated Dec 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
JACKSON CENTER
Doing business as
The Jackson Center for Mental Wellness
Practice address
198 Narrows Dr Ste 105
Birmingham, AL 35242-8663
Phone
(901) 647-8291
NPI assigned
May 23, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2022

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

Authorized official

Name
Ben Harrell
Title
Member
Phone
(901) 647-8291

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

198 Narrows Dr Ste 105
Birmingham, AL 35242-8663

Mailing address

470 North St
Hernando, MS 38632-1732
Phone (901) 647-8291

Other names 1

  • The Jackson Center for Mental Wellness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230821002191 AL Part B Supplier - Clinic/Group Practice 2668834862 Receives reassigned benefits from 2 practitioners
Practice locations: Birmingham, AL

National Provider Directory

National Provider Directory

Locations

198 Narrows Dr
Ste 105
Birmingham, AL 35242
Phone (205) 407-4150

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1653264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670889600000",
    "number": "1912645623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 NORTH ST",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386321732",
            "telephone_number": "901-647-8291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "198 NARROWS DR STE 105",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352428663",
            "telephone_number": "901-647-8291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-23",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "901-647-8291"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Jackson Center for Mental Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Jackson Center for Mental Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Birmingham, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; 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.