Jessica Elise Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2725 Issued in OK

Practice address

2109 S Santa Fe Ave
Moore, OK 73160-2807

Phone

(405) 213-0256

NPI assigned

Dec 28, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Icare Center LLCGroup PAC ID 0840555777, 28 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Icare Center LLC

  • Urgent Care Clinic/Center
  • Harrah, OK
  • NPI 1881190833
  Medicare reassignment Care Compare group
• Medical Resource Management, LLC

  • Urgent Care Clinic/Center
  • Edmond, OK
  • NPI 1104056365
  Medicare reassignment
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  OK

  Medicare reassignment
• Oca MWC LP

  • Family Medicine Physician
  • Midwest City, OK
  • NPI 1417105321
  NPD (past)

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

{
    "created_epoch": "1482883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579132800000",
    "number": "1023553187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12220 GREENLEA CHASE W",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731706010",
            "telephone_number": "405-761-3256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 S SANTA FE AVE",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602807",
            "telephone_number": "405-213-0256"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2525 NW Expressway St Ste 102",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731127200",
            "country_code": "US",
            "telephone_number": "405-213-0192",
            "fax_number": "405-438-0988",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JESSICA",
        "middle_name": "ELISE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-28",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J Carroll Counseling, LLC
• J J Richardson DDS PLLC
• Jerry Jack, DDS
• Jackalope Therapy
• Amy Estelle Jackson, P.T.
• Keri Lee Jackson, PT
• Kylee Jackson, MED, ATC, LAT
• Sasa K Jackson, PA-C
• Madeleine Jacobs, PT, DPT
• Megan R Jacobson, MD

• Physician Assistant in Moore, OK
• Providers in Moore, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; 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.