Active NPI
Mark Jackman
- Foot & Ankle Surgery Podiatrist
- Montgomery, AL
National Provider Identifier
1922593359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- POD001488
- Practice address
- 215 Perry Hill Rd
Montgomery, AL 36109-3725 - Phone
- (180) 145-5538
- NPI assigned
- Jun 27, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | POD001488 | GA | Primary |
Addresses
Primary practice location
215 Perry Hill Rd
Montgomery, AL 36109-3725
Mailing address
8730 Ridgestone CT
Montgomery, AL 36117-8875
Phone (801) 455-5383
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| POD001488 | GA | MD | Foot & Ankle Surgery Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649030400000",
"number": "1922593359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8730 RIDGESTONE CT",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361178875",
"telephone_number": "801-455-5383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 PERRY HILL RD",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361093725",
"telephone_number": "180-145-5538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKMAN",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-27",
"last_updated": "2022-04-04",
"certification_date": "2022-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "GA",
"license": "POD001488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.