Alison W Jackson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

34888 Issued in CO

Practice address

3577 Main Ave
Durango, CO 81301-4028

Phone

(970) 247-8008

Fax

(970) 247-8006

NPI assigned

Jan 18, 2007

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 18, 2014 through Feb 18, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Valley-Wide Health Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Alamosa, CO
  • NPI 1205652047
  NPD (past)

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343088000000",
    "number": "1063565810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3577 MAIN AVE",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813014028",
            "telephone_number": "970-247-8008",
            "fax_number": "970-247-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3577 MAIN AVE",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813014028",
            "telephone_number": "970-247-8008",
            "fax_number": "970-247-8006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALISON",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2012-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "34888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01348887",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Gazak Isaacs, NNP
• Ingrid Lyn Iversen, RPT
• J Ryan Mickelson DDS, Inc.
• Lorielle M Jack
• Robin Oma Jackman, O.D.
• Danette Jackson, RN
• David Christopher Jackson, D.C.
• James Paul Jackson, O.D.
• Tara M Jackson, MA
• Velvet Jackson

• Family Medicine Physician in Durango, CO
• Providers in Durango, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.