NPIMap

Individual provider Active NPI

Joseph Jackson, DO

  • Family Medicine Physician
  • Okolona, MS
National Provider Identifier
1922074806
Registry record updated Mar 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17430 Issued in MS
Practice address
119 Robertson St
Okolona, MS 38860-1620
Phone
(662) 447-3882
Fax
(662) 447-2265
NPI assigned
Feb 28, 2006
Last updated
Mar 8, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17430 MS Primary

Addresses

Primary practice location

119 Robertson St
Okolona, MS 38860-1620

Mailing address

119 Robertson St
Okolona, MS 38860-1620
Phone (662) 447-3882

Other identifiers 1

IdentifierTypeStateIssuer
01371061MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20101006000456 MS Practitioner - Family Practice 2062604242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

119 Robertson St
Okolona, MS 38860-1620
Phone (662) 447-3882

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Clinics Inc Family Medicine CurrentSince Oct 2, 2001 Accepting new patients
North Mississippi Medical Center Current Accepting new patients
North Mississippi Medical Clinics Inc CurrentSince Oct 2, 2001 Accepting new patients
North Mississippi Medical Clinics Inc Past Accepting new patients

Locations

208 Country Club Rd
Houston, MS 38851
Phone (662) 456-3437

119 Robertson St
Okolona, MS 38860
Phone (662) 447-3882

3411 W Main St
Tupelo, MS 38801
Phone (662) 844-9376

844 S Madison St
Tupelo, MS 38801
Phone (662) 377-5400

845 S Madison St
Tupelo, MS 38801
Phone (601) 790-5025

903 Mississippi Dr
Tupelo, MS 38804
Phone (662) 377-4652

Interoperability endpoints

  • Direct secure messaging: josephjackson@nmhs.medalliesdirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299542400000",
    "number": "1922074806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 ROBERTSON ST",
            "city": "OKOLONA",
            "state": "MS",
            "postal_code": "388601620",
            "telephone_number": "662-447-3882",
            "fax_number": "662-447-2265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 ROBERTSON ST",
            "city": "OKOLONA",
            "state": "MS",
            "postal_code": "388601620",
            "telephone_number": "662-447-3882",
            "fax_number": "662-447-2265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOSEPH",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2011-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "17430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01371061",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Okolona, MS

Sources for this page

Verify at the official NPI Registry.