Active NPI
Sheldon Jackson, PA
- Physician Assistant
- Layton, UT
National Provider Identifier
1003829086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 6246293-1206
- Practice address
- 1240 E Highway 193
Suite G-1
Layton, UT 84040-8544 - Phone
- (801) 771-1331
- NPI assigned
- Aug 14, 2006
- Last updated
- Dec 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 6246293-1206 | UT | Primary |
Addresses
Primary practice location
1240 E Highway 193
Suite G-1
Layton, UT 84040-8544
Mailing address
1240 E Highway 193
Suite G-1
Layton, UT 84040-8544
Phone (801) 771-1331
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00424201 | Other | UT | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6246293-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Layton Internal Medicine LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba East Layton Medical CLinic
- Internal Medicine Physician
- Layton, UT
- NPI 1770527871
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196985600000",
"number": "1003829086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1240 E HIGHWAY 193",
"address_2": "SUITE G-1",
"city": "LAYTON",
"state": "UT",
"postal_code": "840408544",
"telephone_number": "801-771-1331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1240 E HIGHWAY 193",
"address_2": "SUITE G-1",
"city": "LAYTON",
"state": "UT",
"postal_code": "840408544",
"telephone_number": "801-771-1331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHELDON",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2007-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "6246293-1206",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00424201",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Layton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.