NPIMap

Organization Active NPI

Jackson Hospital and Clinic, Inc.

Doing business as Jackson Clinic Pediatrics

  • Pediatrics Physician
  • Montgomery, AL
National Provider Identifier
1952949968
Registry record updated Dec 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
JACKSON HOSPITAL AND CLINIC, INC.
Doing business as
Jackson Clinic Pediatrics
Practice address
4154 Carmichael Rd
Montgomery, AL 36106-2866
Phone
(334) 271-5959
Fax
(334) 272-8775
NPI assigned
Dec 20, 2019
Last updated
Dec 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2019

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

Authorized official

Name
Tara Herring
Title
Revenue Cycle Director
Phone
(334) 240-2337

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

4154 Carmichael Rd
Montgomery, AL 36106-2866

Mailing address

1722 Pine St Ste 203
Montgomery, AL 36106-1158
Phone (334) 293-8736

Other names 1

  • Jackson Clinic Pediatrics Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tara.herring@jackson.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040414000971 AL Part B Supplier - Clinic/Group Practice 0547254153 Receives reassigned benefits from 247 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Carol Anders Tyson Mano71 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Locations

4154 Carmichael Rd
Montgomery, AL 36106
Phone (334) 271-5959

NPI Registry JSON

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576800000000",
    "number": "1952949968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 PINE ST STE 203",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061158",
            "telephone_number": "334-293-8736",
            "fax_number": "334-293-8738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4154 CARMICHAEL RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361062866",
            "telephone_number": "334-271-5959",
            "fax_number": "334-272-8775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOSPITAL AND CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-20",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A",
        "authorized_official_last_name": "HERRING",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "334-240-2337"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tara.herring@jackson.org",
            "affiliation": "N",
            "address_1": "4154 Carmichael Rd",
            "city": "Montgomery",
            "state": "AL",
            "country_code": "US",
            "postal_code": "361062866",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Jackson Clinic Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 20, 2019; 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.