Active NPI
Gregory R Jackson, MD
- Diagnostic Radiology Physician
- Council Bluffs, IA
National Provider Identifier
1982640090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 26056
- Practice address
- 800 Mercy Hospital
Alegent Mercy Hospital
Council Bluffs, IA 51503 - Phone
- (712) 328-5000
- NPI assigned
- Jun 20, 2006
- Last updated
- Mar 7, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 17050 | NE | |
| Diagnostic Radiology Physician | 2085R0202X | 26056 | IA | Primary |
Addresses
Primary practice location
800 Mercy Hospital
Alegent Mercy Hospital
Council Bluffs, IA 51503
Mailing address
PO Box 4460
Omaha, NE 68104
Phone (866) 491-5807
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4043109 | Medicaid | IA | |
| 7043109 | Medicaid | IA | |
| 8043109 | Medicaid | IA | |
| 17050 | Other | NE | LICENSE # |
| 41360 | Other | IA | BCBS |
| 6043109 | Medicaid | IA | |
| AJ2110310 | Other | IA CONTROLLED SUBSTANCE | |
| 35534 | Other | NE | BCBS |
| 5043109 | Medicaid | IA | |
| 207 | Other | MIDLANDS | |
| 26056 | Other | IA LICENSE # |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26056 | IA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oncology Hematology West, PC | Past | Accepting new patients | |
| Simonmed Imaging Nebraska LLC | Past | Accepting new patients | |
| Northwest Iowa Hospital Corporation | Past | Accepting new patients | |
| Professional Medical Imaging LLC | Past | Accepting new patients | |
| Oncology Hematology West, PC | Past | Accepting new patients |
Organizations & group practices 5
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.
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dba Nebraska Cancer Specialist
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-
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1982640090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4460",
"city": "OMAHA",
"state": "NE",
"postal_code": "68104",
"telephone_number": "866-491-5807",
"fax_number": "913-491-0411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 MERCY HOSPITAL",
"address_2": "ALEGENT MERCY HOSPITAL",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "51503",
"telephone_number": "712-328-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "GREGORY",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-20",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "NE",
"license": "17050",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IA",
"license": "26056",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4043109",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7043109",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8043109",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "17050",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "41360",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6043109",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IA CONTROLLED SUBSTANCE",
"identifier": "AJ2110310",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "35534",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5043109",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS",
"identifier": "207",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IA LICENSE #",
"identifier": "26056",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Council Bluffs, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.