Mark R. Jackson, MD

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

5929640-1205 Issued in UT

Practice address

1474 E Erda Way
Tooele, UT 84074-9737

Phone

(435) 849-0779

NPI assigned

Mar 30, 2006

Last updated

Mar 21, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX, NM2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Emergency Medicine

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fedko Emergency Physicians New Mexico, LLCGroup PAC ID 4880934389, 53 clinicians

Ess of Nacogdoches LLCGroup PAC ID 3375821630, 27 clinicians

Emergency Staffing Solutions IncGroup PAC ID 9830001650, 57 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rehoboth McKinley Christian Health Care Services Hospital, Gallup, NM, CCN 321313
• Nacogdoches Memorial Hospital Hospital, Nacogdoches, TX, CCN 450508
• Cibola General Hospital Hospital, Grants, NM, CCN 321308
• Northern Rockies Medical Center Hospital, Cut Bank, MT, CCN 271337

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: fmcmjacks@yourcarecommunity.org
• Direct secure messaging: markjackson@rghnm.medalliesdirect.net

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.

• Emergency Staffing Solutions Inc

  • Emergency Medicine Physician
  • Many, LA
  • NPI 1477590974

  NM

  Medicare reassignment Care Compare group NPD
• Ess of Nacogdoches LLC

  • Emergency Medicine Physician
  • Nacogdoches, TX
  • NPI 1780139956
  Medicare reassignment Care Compare group NPD
• Fedko Emergency Physicians New Mexico LLC

  • Emergency Medicine Physician
  • Grants, NM
  • NPI 1770047441
  Medicare reassignment Care Compare group NPD
• Cibola General Hospital Corporation

  dba Cibola General Hospital

  • Critical Access Hospital
  • Grants, NM
  • NPI 1780677039
  Medicare reassignment NPD
• Ess Hospitalist LLC

  • Hospitalist Physician
  • Crossett, AR
  • NPI 1881967305

  NM

  Medicare reassignment NPD
• Ess of Fairfield LLC

  • Emergency Medicine Physician
  • Fairfield, TX
  • NPI 1588132856
  Medicare reassignment NPD
• HCC of Fairfield LLC

  • Internal Medicine Physician
  • Fairfield, TX
  • NPI 1487122750
  Medicare reassignment NPD
• Hospital Care Consultants Region II Inc

  • Internal Medicine Physician
  • West Memphis, AR
  • NPI 1558491449

  NM

  Medicare reassignment NPD
• Las Cruces HB Medical Services LLC

  dba MountainView Regional Medical Center

  • Emergency Medicine Physician
  • Las Cruces, NM
  • NPI 1598446171
  Medicare reassignment
• Roosevelt County Special Hospital District

  dba Roosevelt General Hospital

  • General Acute Care Hospital
  • Portales, NM
  • NPI 1073517058
  NPD
• Emergency Physicians Integrated Care, LLC

  • Emergency Medicine Physician
  • Salt Lake City, UT
  • NPI 1578598199

  Emergency Medical Services

  NPD (past)
• BC Missouri Emergency Physicians, LLP

  • Emergency Medicine Physician
  • Sullivan, MO
  • NPI 1679598247
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cibola General Hospital Corporation

  dba Cibola General Hospital

  • Critical Access Hospital
  • Grants, NM
  • NPI 1780677039
  Care Compare affiliation
• Nacogdoches County Hospital District

  dba NCHD Memorial Hospital

  • Rural Acute Care Hospital
  • Nacogdoches, TX
  • NPI 1801831748
  Care Compare affiliation
• Northern Rockies Medical Center, Inc.

  dba Logan Health - Cut Bank

  • Critical Access Hospital
  • Cut Bank, MT
  • NPI 1831143080
  Care Compare affiliation
• Rehoboth McKinley Christian Health Care Services, Inc

  • Rural Health Clinic/Center
  • Gallup, NM
  • NPI 1689779860

  Hospital

  Care Compare affiliation
• Rehoboth McKinley Christian Health Care Services, Inc.

  dba RMCHCS Hospital

  • Critical Access Hospital
  • Gallup, NM
  • NPI 1720084999
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458518400000",
    "number": "1003877077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1474 E ERDA WAY",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840749737",
            "telephone_number": "435-849-0779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1474 E ERDA WAY",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840749737",
            "telephone_number": "435-849-0779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARK",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2016-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "UT",
            "license": "5929640-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D6378",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ihc Health Services Inc (Tooele InstaCare)
• Ihc Health Services, Inc. (Tooele Valley Dialysis)
• Infocus Optics LLC (Infocus Optical)
• Integrate Psychotherapy PLLC
• Itooth, LLC
• Lu Ann Jacobs-Peterson, APRN FNP
• Carin Renee James
• Chad Jarvis, DA-C
• Jay M. Spector,M.D.,LLC (Oasis Family Medicine)
• Jed C Winder OD, PC (Tooele Vision Center)

• Emergency Medical Services (Emergency Medicine) Physician in Tooele, UT
• Providers in Tooele, UT by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.