MARK A JACKSON MD PLC (NPI# 1740439025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740439025 |
| Entity Type | Organization |
| Organization Name | MARK A JACKSON MD PLC |
| Practice Address |
1000 Pavillions Cir Traverse City MI 49684-3198 |
| Mailing Address |
Po Box 1267 Traverse City MI 49685-1267 |
| Practice Telephone | 2319350913 |
| Practice Fax Number | 2319350984 |
| Mailing Telephone | 2319350913 |
| Mailing Fax Number | 2319350984 |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2008-12-18 |
| Authorized Official Name | DR. MARK A JACKSON (PHYSICIAN/OWNER) |
| Authorized Official Telephone | 2319350913 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
4301051555 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | GROUP NPI | 1740439025 | 01 |
| MI | BCBS ID# | 080B813500 | 01 |
| MI | IND NPI | 1073585238 | 01 |
| MI | BCBS PIN# | 0802802421 | 01 |
| MI | MEDICARE IND PTAN | MI1114001 | 01 |
| MI | BCBS GROUP ID# | 0B81350 | 01 |
| MI | MEDICARE GROUP | 0MI1114 | 01 |
| MI | 1073585238 | 05 |
| Street Address |
1000 PAVILLIONS CIR |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49684-3198 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174525042 | Kathy Diane Reid | Nurse Practitioner | 1000 Pavillions Cir, Traverse City, MI 49684-3198 | 2005-08-11 |
| 1558977728 | Michael Newberry | Occupational Therapist | 1000 Pavillions Cir, Traverse City, MI 49684-3198 | 2020-09-22 |
| 1063050334 | Hannah Schweikart | Occupational Therapist | 1000 Pavillions Cir, Traverse City, MI 49684-3198 | 2019-12-17 |
| 1750846580 | Katheryn Marie Shrift-ackerman | Speech-Language Pathologist | 1000 Pavillions Cir, Traverse City, MI 49684-3198 | 2019-02-06 |
| 1083179956 | Lauren Marie Rinke | Speech-Language Pathologist | 1000 Pavillions Cir, Traverse City, MI 49684-3198 | 2019-02-05 |
| 1245711548 | Nicole Lynn Dewey | Occupational Therapist | 1000 Pavillions Cir, Traverse City, MI 49684-3198 | 2018-08-24 |
| 1467931477 | Jacqueline Michele Aicher | Speech-Language Pathologist | 1000 Pavillions Cir, Traverse City, MI 49684-3098 | 2018-08-09 |
| 1730681586 | Kimberly Stover Rosso | Physical Therapist | 1000 Pavillions Cir, Traverse City, MI 49684-3198 | 2018-03-07 |
| 1851893879 | Carrie Leah Baldwin | Physical Therapist | 1000 Pavillions Cir, Traverse City, MI 49684-3198 | 2018-03-06 |
| 1295237493 | Jennifer Balogh | Occupational Therapist | 1000 Pavillions Cir, Traverse City, MI 49684-3198 | 2018-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124641758 | Karen Anne Paulosky | Registered Nurse | 226 S Madison St, Traverse City, MI 49684 | 2020-05-18 |
| 1891314795 | Jaclyn Elizabeth Sylvain | Student in an Organized Health Care Education/Training Program | Munson Family Practice Center, 1400 Medical Campus Drive, Traverse City, MI 49684 | 2020-04-10 |
| 1285282988 | Madelyn Drumm | Dietitian, Registered | 217 S. Madison St., Suite 3022, Traverse City, MI 49684 | 2019-08-27 |
| 1265917686 | Kacie Danielle Heading | Social Worker | 12719 S. West Bay Shore Drive, Suite 9, Traverse City, MI 49684 | 2018-10-02 |
| 1881178325 | Jacob White Ph.d., Pllc | Psychologist | 3537 W. Front Street, Suite F, Traverse City, MI 49684 | 2018-09-20 |
| 1144702572 | Constance Baab, Phd, Lmsw, Pllc | Social Worker | 3301 Veterans Drive Suite 127, Traverse City, MI 49684 | 2018-09-01 |
| 1346732880 | The Skin Cancer and Dermatology Center Plc | Dermatology | 1225 W Front St Ste 2, Traverse City, MI 49684 | 2018-05-31 |
| 1790283851 | Lisa Louise Kleyps | Massage Therapist | 3337 W. South Airport Road #2, Traverse City, MI 49684 | 2018-01-24 |
| 1114447646 | Brittany Alexandra Prior | Physical Therapist | 3899 W Front Sreet, Unit 3, Traverse City, MI 49684 | 2017-06-26 |
| 1568902963 | Jennifer Scott | Behavior Technician | 515 W 14th St Unit D, Traverse City, MI 49684 | 2017-03-03 |
| Find all providers in zip 49684 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215989868 | Geriatric Physician Staffing, P. C. | Family Medicine | 1513 N Orchard Dr, Traverse City, MI 49686-1946 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124651435 | Navihealth Michigan Hbpc, PC | Family Medicine | 2 Towne Sq Ste 275, Southfield, MI 48076-3719 | 2020-02-14 |
| 1215481981 | Metro Physicians Pllc | Family Medicine | 5555 Conner St Ste 2075, Detroit, MI 48213-3492 | 2016-08-10 |
| 1447610704 | Provider Service Organization | Family Medicine | 7233 Provincial Ct, Canton, MI 48187-2121 | 2016-02-29 |
| 1659704633 | David Gordon Reed | Family Medicine | 3620 Chula Vista Dr, East Jordan, MI 49727-8629 | 2013-08-14 |
| 1174800411 | New Life Medical Senior Care PC | Family Medicine | 105 S Wildwood Xing Apt 20, Ludington, MI 49431-8719 | 2011-11-15 |
| 1306134085 | Jeremiah Lopez | Family Medicine | 804 Service Rd Ste A235, East Lansing, MI 48824-7015 | 2011-07-15 |
| 1770819344 | Midmichigan Geriatric Services Pllc | Family Medicine | 4823 Henry Dr, Saginaw, MI 48638-5631 | 2009-11-02 |
| 1982871265 | Daniel R Smalley | Family Medicine | 105 S Wildwood Crossing 20, Ludington, MI 49431-8719 | 2008-05-15 |
| 1821267832 | Eastlake Medical Center | Family Medicine | 646 Chene St, Detroit, MI 48207-3979 | 2008-02-23 |
| 1740479278 | William Kerr Md PC | Family Medicine | 650 N Center Ave, Suite 3 B, Gaylord, MI 49735-1682 | 2007-10-22 |
| Find all providers with the same taxonomy | ||||
| City | TRAVERSE CITY |
| Zip Code | 49684 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.