GREGORY R JACKSON (NPI# 1982640090) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982640090 |
| Entity Type | Individual |
| Full Name | GREGORY R JACKSON |
| Credential | MD |
| Practice Address |
800 Mercy Hospital Alegent Mercy Hospital Council Bluffs IA 51503 |
| Mailing Address |
Po Box 4460 Omaha NE 68104 |
| Practice Telephone | 7123285000 |
| Mailing Telephone | 8664915807 |
| Mailing Fax Number | 9134910411 |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2010-02-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
26056 | IA | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
17050 | NE | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | BCBS | 35534 | 01 |
| IA | 6043109 | 05 | |
| DEA # | BJ7659088 | 01 | |
| IA | 7043109 | 05 | |
| IA LICENSE # | 26056 | 01 | |
| MIDLANDS | 207 | 01 | |
| IA | 4043109 | 05 | |
| IA | 5043109 | 05 | |
| IA | 8043109 | 05 | |
| IA CONTROLLED SUBSTANCE | AJ2110310 | 01 | |
| NE | LICENSE # | 17050 | 01 |
| IA | BCBS | 41360 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295194124 | Gregory L Jackson | Social Worker | 342 W Progress Rd, Prentiss, MS 39474-5221 | 2016-02-20 |
| 1811170293 | Gregory Emory Jackson | Pharmacist | 526 W 30th Street, Ny, NY 10001 | 2007-12-09 |
| 1801970769 | Gregory Wayne Jackson | Dentist | 6435 S Pulaski Rd, Chicago, IL 60629-5148 | 2006-10-25 |
| 1184738825 | Gregory Mann Jackson | Specialist | 4220 Mccullough Ave, San Antonio, TX 78212-1910 | 2006-08-19 |
| 1134158009 | Gregory Alan Jackson | Physical Therapist | 5501 Swift Rd, Sarasota, FL 34231-6209 | 2006-07-02 |
| 1356306203 | Gregory Lee Jackson | Specialist/Technologist | 3821 Everetts Dl, Lexington, KY 40514-1185 | 2006-04-20 |
| 1568092088 | Gregory Christopher Jackson | Psychologist | 4141 Geary Blvd, San Francisco, CA 94118-3109 | 2020-01-23 |
| 1346747110 | Gregory Jackson | Student in an Organized Health Care Education/Training Program | 1161 21st Ave S, Nashville, TN 37232-0004 | 2018-04-09 |
| 1285167304 | Gregory M. Jackson II | Nurse Practitioner | 8600 Wurzbach Rd, Suite 1110, San Antonio, TX 78240-4330 | 2017-04-05 |
| 1942651708 | Gregory Jackson | Physical Therapy Assistant | 9685 Chillicothe Rd, Kirtland, OH 44094-8503 | 2016-06-23 |
| Street Address |
800 MERCY HOSPITAL ALEGENT MERCY HOSPITAL |
| City | COUNCIL BLUFFS |
| State | IA |
| Zip Code | 51503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326654377 | Michael Menendez | Counselor | N 6th Street and Ave E, Council Bluffs, IA 51503 | 2020-09-16 |
| 1417598301 | Katherine E Turner | Counselor | 2303 Butler Street, Council Bluffs, IA 51503 | 2019-10-02 |
| 1992354666 | Phs Council Bluffs, Inc | Skilled Nursing Facility | 16 Valley View Drive, Council Bluffs, IA 51503 | 2019-09-05 |
| 1629429451 | Nathan Charles Shumway | Podiatrist | 320 Mckenzie Ave Ste 102, Council Bluffs, IA 51503 | 2016-06-22 |
| 1699131797 | Bluffs Pain Management LLC | Pain Medicine | 201 Ridge St Suite 102, Council Bluffs, IA 51503 | 2016-01-06 |
| 1811246903 | Georgia Ann Boeck | Hearing Instrument Specialist | 900 Woodbury Avenue, Suite 8b, Council Bluffs, IA 51503 | 2012-09-05 |
| 1790055796 | Wendy Jane'e Zenor | Licensed Practical Nurse | 1525 Rolling Hills Loop, Council Bluffs, IA 51503 | 2012-01-06 |
| 1649579186 | Mohana K Loya | Internal Medicine | 933 E Pierce St., Council Bluffs, IA 51503 | 2011-03-23 |
| 1568761369 | Brenda Kay Sennett | Occupational Therapist | 1600 Mcpherson Avenue, Council Bluffs, IA 51503 | 2011-03-18 |
| 1710129671 | Heart Lung and Vascular Surgery PC | Specialist | 210 Ridge, Jennie Edmundsen Hospital, Council Bluffs, IA 51503 | 2009-03-24 |
| Find all providers in zip 51503 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710923800 | Donald T Van De Water | Radiology | 800 Mercy Dr, Alegent Mercy Hospital Dept of Radiology, Council Bluffs, IA 51503-3128 | 2006-06-20 |
| 1518902709 | Gregory G Eckert | Radiology | 800 Mercy Dr, Alegent Mercy Hospital, Council Bluffs, IA 51503 | 2006-06-19 |
| 1952359762 | Annabel Galva | Radiology | 933 E Pierce St, Council Bluffs, IA 51503-4626 | 2006-05-04 |
| 1699733410 | Jason Andrew Arthur | Radiology | 933 E Pierce St, Council Bluffs, IA 51503 | 2006-05-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821411547 | Robert Picchiotti | Radiology | 2189 Saint Andrews Cir, Bettendorf, IA 52722-6655 | 2014-01-31 |
| 1295097970 | Alexander Macrae Harvin | Radiology | 5095 S Shore Dr, Clear Lake, IA 50428 | 2012-06-08 |
| 1871825281 | Gregory Day | Radiology | 2609 Bittersweet Pl, Burlington, IA 52601-2510 | 2010-02-10 |
| 1891921813 | Christopher M. Luty | Radiology | 378 N Scott Blvd, Iowa City, IA 52245-4110 | 2009-06-04 |
| 1609012145 | Kfl Radiology Plc | Radiology | 1002 River Forest Ct, Fort Dodge, IA 50501-7019 | 2009-01-06 |
| 1447400288 | Sarah Pauley | Radiology | Radiology Consultants of Iowa, Plc, 1948 1st Ave Ne, Cedar Rapids, IA 52402-5321 | 2008-09-29 |
| 1982869764 | Khaled Ali Hamada | Radiology | 801 Fifth Street, Sioux City, IA 51101-1326 | 2008-07-22 |
| 1902068083 | Ashlesha Sharma | Radiology | 3617 Ross Rd, Ames, IA 50014 | 2008-06-30 |
| 1598961187 | Shiv Patel | Radiology | 200 Hawkins Dr Dept Of, Iowa City, IA 52242 | 2007-06-21 |
| 1164640041 | Bryan P Navarette | Radiology | 1010 4th St Sw Ste 100, Mason City, IA 50401-2856 | 2007-04-23 |
| Find all providers with the same taxonomy | ||||
| City | COUNCIL BLUFFS |
| Zip Code | 51503 |
Please comment or provide details below to improve the information on GREGORY R JACKSON.
| 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.