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J. PHILLIP JACKSON M.D. NPI 1881675080


NPI Information

NPI: 1881675080
Provider Name: J. PHILLIP JACKSON, M.D.
Classification: Family Medicine - 207Q00000X
Entity Type: Individual
Organization: FORT WAYNE MEDICAL EDUCATION PROGRAM

PECOS Registration: Yes

Address:
7980 W JEFFERSON BLVD
FORT WAYNE, IN
ZIP 46804
Phone: (260) 436-9454
Get Directions

J. Phillip Jackson, M.D. is a family medicine in Fort Wayne, IN with 36 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. J. Phillip Jackson, M.D. NPI is 1881675080. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: INDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:1988

The provider's business location address is:

7980 W JEFFERSON BLVD
FORT WAYNE, IN
ZIP 46804-170
Phone: (260) 436-9454
Fax: (260) 436-7836

The NPI 1881675080 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Urinalysis, manual test (HCPCS:81002)
  • Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)
  • Pneumococcal vaccine for injection into muscle (HCPCS:90670)
  • Administration of pneumococcal vaccine (HCPCS:G0009)
  • Removal of impact ear wax, one ear (HCPCS:69210)
  • Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)

The enumeration date for this NPI number is 11/7/2005 and was last updated on 2/22/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine01037752AINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1000000000892OTHERMPLAN
2080121955OTHERINDIANARAILROAD MEDICARE
3M400048217MEDICARE PININDIANA
41431OTHERPHYSICIANS HEALTH PLAN
5000000091890OTHERBLUE CROSS BLUE SHIELD
6E11385MEDICARE UPIN
7925500OMEDICARE PININDIANA
8925510BMEDICARE PININDIANA
9100462820MEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.