DR. JAY A JACKSON M.D. NPI 1558360743

NPI Information

  • NPI: 1558360743
  • Provider Name: DR. JAY A JACKSON, M.D.
  • Classification: Internal Medicine - 207RC0000X
  • Specialization: Cardiovascular Disease
  • Entity Type: Individual
  • Address: 9119 W 74TH ST
    SUITE 350
    SHAWNEE MISSION, KS
    ZIP 66204
  • Phone: (913) 789-3290

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NPI Details

DR. Jay A Jackson, M.D. is a cardiovascular disease internal medicine in Shawnee Mission, KS. The provider is an internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. DR. Jay A Jackson, M.D. NPI is 1558360743. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

9119 W 74TH ST
SUITE 350
SHAWNEE MISSION, KS
ZIP 66204-215
Phone: (913) 789-3290
Fax: (913) 789-3208

The enumeration date for this NPI number is 7/19/2005 and was last updated on 9/11/2013.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RC0000XInternal MedicineCardiovascular DiseaseR8D86MISSOURIYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1100168130JMEDICAIDKANSAS
21558360743MEDICAIDMISSOURI
3P00643402MEDICARE PINMISSOURI
44016591MEDICARE ID-TYPE UNSPECIFIEDMISSOURI
5C51601MEDICARE UPINMISSOURI
6201986726MEDICAIDMISSOURI
74016591AMEDICARE PINKANSAS
8Y056591MEDICARE PINMISSOURI

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: 11/21/2025

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