DR. ROGER P JACKSON (NPI# 1811044548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811044548 |
| Entity Type | Individual |
| Full Name | DR. ROGER P JACKSON |
| Credential | M.D. |
| Practice Address |
2750 Clay Edwards Dr Ste 600 North Kansas City MO 64116-3258 |
| Practice Telephone | 8164716611 |
| Practice Fax Number | 8164716192 |
| Mailing Telephone | 8164716611 |
| Mailing Fax Number | 8164716192 |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2012-08-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
R5717 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBS OF KC | 07979011 | 01 | |
| UNITED HEALTHCARE | 09-00221 | 01 | |
| RAILROAD MEDICARE | 200018411 | 01 | |
| AETNA | 4571391 | 01 | |
| DEA | BJ0717263 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881214872 | Roger Lee Jackson II | Emergency Medical Technician, Intermediate | 713 Clifton Rd Se, Atlanta, GA 30316-2229 | 2020-04-20 |
| 1366957342 | Roger Dale Jackson | Counselor | 8200 Georgia St, Merrillville, IN 46410-6227 | 2017-12-12 |
| 1013135086 | Roger Jackson | Dentist | 11144 N Frank Lloyd Wright Blvd, Ste E8, Scottsdale, AZ 85259-2646 | 2007-04-23 |
| 1932177417 | Roger K Jackson | Psychiatry & Neurology | 9601 Steilacoom Blvd Sw, Tacoma, WA 98498-7213 | 2006-03-09 |
| Street Address |
2750 CLAY EDWARDS DR STE 600 |
| City | NORTH KANSAS CITY |
| State | MO |
| Zip Code | 64116-3258 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548317118 | David K. Ebelke | Orthopaedic Surgery | 2750 Clay Edwards Dr Ste 600, North Kansas City, MO 64116-3258 | 2007-01-04 |
| 1912327644 | Paul Frydenlund | Neurological Surgery | 2750 Clay Edwards Dr Ste 600, North Kansas City, MO 64116-3258 | 2014-04-21 |
| 1518149962 | Meritas Health Corporation | Surgery | 2750 Clay Edwards Dr Ste 600, North Kansas City, MO 64116-3258 | 2007-11-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326503830 | Ladeja Holland | Student in an Organized Health Care Education/Training Program | 4421 N Oak Trfy, Kansas City, MO 64116 | 2019-02-08 |
| 1982179388 | Casady's Counseling | Counselor | 1201 Nw Briarcliff Pkwy Ste 200 Office233, Kansas City, MO 64116 | 2018-10-11 |
| 1427543818 | Amanda E Foster | Physical Therapist | 3810 N Mulberry Drive 202, Kansas City, MO 64116 | 2018-06-27 |
| 1992290555 | Lucas J Mathes | Physician Assistant | 2790 Clay Edwards Drive, Suite 650, North Kansas City, MO 64116 | 2018-06-26 |
| 1952828816 | Danielle Marie Rush | Physical Therapist | 1501 Nw 38th St., Apt. 305, Kansas City, MO 64116 | 2017-08-23 |
| 1992229629 | Ankita Bhakta | Physical Therapy Assistant | 4407 N Mulberry Dr, Kansas City, MO 64116 | 2017-08-03 |
| 1720430945 | Deon Hicks | Physical Therapist | 851 Nw 45th Street, Suite 209, Kansas City, MO 64116 | 2016-07-12 |
| 1851712228 | Cindy Eldridge | Counselor | 1201 Nw Briarcliff Pkwy Ste 200, Kansas City, MO 64116 | 2014-01-02 |
| 1841629904 | Jamie Lyn Jackson | Specialist/Technologist | 2790 Clay Edwards Dr. Ste #650, North Kansas City, MO 64116 | 2013-11-08 |
| 1487099388 | Lisa M Grasing | Family Medicine | 4150 N. Mulberry Dr, Suite 160, Kansas City, MO 64116 | 2013-05-06 |
| Find all providers in zip 64116 | ||||
| Taxonomy Code | 207XS0117X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Orthopaedic Surgery of the Spine |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548317118 | David K. Ebelke | Orthopaedic Surgery | 2750 Clay Edwards Dr Ste 600, North Kansas City, MO 64116-3258 | 2007-01-04 |
| 1497802060 | Spine Surgery, Ltd. | Orthopaedic Surgery | 2790 Clay Edwards Dr Ste 630, North Kansas City, MO 64116 | 2007-01-04 |
| 1609923366 | Spine & Scoliosis Surgery, Inc. | Orthopaedic Surgery | 2790 Clay Edwards Dr Ste 630, North Kansas City, MO 64116 | 2007-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740839893 | Midwest Orthopedic and Spine Specialists | Orthopaedic Surgery | 14825 N Outer 40 Rd Ste 310, Chesterfield, MO 63017-2152 | 2019-09-10 |
| 1396305348 | Advanced Spine Institute LLC | Orthopaedic Surgery | 3009 N Ballas Rd Ste 320a, Saint Louis, MO 63131-2324 | 2019-06-20 |
| 1871092882 | Spine Cin of Kansas City LLC | Orthopaedic Surgery | 111 W 10th St Ste 101, Kansas City, MO 64105-1700 | 2018-02-05 |
| 1689173692 | Spine Cin of St Louis LLC | Orthopaedic Surgery | 11628 Old Ballas Rd # 344, Saint Louis, MO 63141-7030 | 2018-02-05 |
| 1881193894 | Optimal Health of Mo, LLC | Orthopaedic Surgery | 11628 Old Ballas Rd # 345, Saint Louis, MO 63141-7030 | 2018-02-05 |
| 1386010684 | St. Peters Bone & Joint Surgery, Inc. | Orthopaedic Surgery | 4651 Hwy K, O'fallon, MO 63368 | 2015-08-20 |
| 1043315385 | John D Spears | Orthopaedic Surgery | 1616 Southridge Dr, Ste 202, Jefferson City, MO 65109-5677 | 2006-09-13 |
| 1952364796 | Donald A Degrange | Orthopaedic Surgery | 621 S New Ballas Rd Ste 142a, Saint Louis, MO 63141-8254 | 2006-04-11 |
| 1336140177 | William Blake Rodgers | Orthopaedic Surgery | 2505 Mission Dr, Suite 200, Jefferson City, MO 65109-9508 | 2005-08-02 |
| 1851390645 | Paul Milton Olive | Orthopaedic Surgery | 3126 S Jackson Ave, Ste 200, Joplin, MO 64804-2534 | 2005-07-14 |
| Find all providers with the same taxonomy | ||||
| City | NORTH KANSAS CITY |
| Zip Code | 64116 |
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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.