NPIMap

Individual provider Active NPI

Melvin L Jackson, MD

  • Emergency Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1922049295
Registry record updated Feb 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
G32876 Issued in CA
Practice address
1225 Wilshire Boulevard
Good Samaritan Hospital
Los Angeles, CA 90017-2395
Phone
(213) 977-2423
Fax
(213) 202-7028
NPI assigned
Jun 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 27, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G32876 CA Primary
Internal Medicine Physician 207R00000X G32876 CA

Addresses

Primary practice location

1225 Wilshire Boulevard
Good Samaritan Hospital
Los Angeles, CA 90017-2395

Mailing address

2550 North Hollywood Way
Suite 204
Burbank, CA 91505-5040
Phone (818) 557-0135

Other identifiers 3

IdentifierTypeStateIssuer
G32876OtherCABLUE CROSS
00G328760OtherBLUE SHIELD
00G328760MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031229000529 CA Practitioner - Emergency Medicine 6002714037 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
32876CAMDChiropractor
G32876CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
San Dimas Emergency Medical Associates Inc. Emergency Medicine CurrentSince Feb 1, 2016 Accepting new patients
Montclair Emergency Medical Associates Emergency Medicine CurrentSince Jan 26, 2016 Accepting new patients
Sherman Oaks Emergency Medical Associates Emergency Medicine PastSince Nov 15, 2020 Accepting new patients
Vepema Medical Group Emergency Medicine Past Accepting new patients
Team Physicians of California Medical Group Inc Emergency Medicine Past Accepting new patients
Maged a. Tanios, MD, Inc Past Accepting new patients
Southern California Pulmonologists and Intensivists Network Past Accepting new patients
Prairie Schooner Emergency Physicians, a Medical Corporation Emergency Medicine Past Accepting new patients
Glendale Emergency Medical Associates, Inc Emergency Medicine Past Accepting new patients
Centinela Freeman Emergency Medical Associates Emergency Medicine Past Accepting new patients
Max Franklin Lebow, a Medical Corporation Emergency Medicine Past Accepting new patients

Locations

5000 San Bernardino St
Montclair, CA 91763
Phone (909) 625-4111

1350 W Covina Blvd
San Dimas, CA 91773
Phone (909) 394-2745

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235692800000",
    "number": "1922049295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 NORTH HOLLYWOOD WAY",
            "address_2": "SUITE 204",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915055040",
            "telephone_number": "818-557-0135",
            "fax_number": "818-557-1394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 WILSHIRE BOULEVARD",
            "address_2": "GOOD SAMARITAN HOSPITAL",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900172395",
            "telephone_number": "213-977-2423",
            "fax_number": "213-202-7028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELVIN",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2009-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G32876",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G32876",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "G32876",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G328760",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G328760",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.