Brian John Jackson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9111499 Issued in FL

Practice address

391 Lee Blvd Ste 300
Lehigh Acres, FL 33936-4973

Phone

(239) 369-4088

NPI assigned

Sep 19, 2018

Last updated

Mar 14, 2019By 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

Medicare fee-for-service enrollment

Enrolled in FL, CO2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Intermountain Medical Group Grand Junction, LLCGroup PAC ID 3779707856, 297 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health St. Mary's Regional Hospital Hospital, Grand Junction, CO, CCN 060023

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Intermountain Medical Group Grand Junction, LLC

  • Orthopaedic Surgery Physician
  • Grand Junction, CO
  • NPI 1356765556
  Medicare reassignment Care Compare group
• Cape Coral Hospitalists Inc

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1336209790
  Medicare reassignment
• Keys Cardiology PA

  • Cardiovascular Disease Physician
  • Lehigh Acres, FL
  • NPI 1386740033
  Medicare reassignment
• Intermountain Medical Group Grand Junction, LLC

  dba Wellington OB-GYN Clinic

  • Obstetrics & Gynecology Physician
  • Grand Junction, CO
  • NPI 1083335079
  NPD
• Intermountain Medical Group Grand Junction, LLC

  dba DME - Wellington Neurosurgery Clinic

  • Durable Medical Equipment & Medical Supplies
  • Grand Junction, CO
  • NPI 1609737618
  NPD

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

• St Mary's Hospital and Medical Center, Inc

  dba St Mary's CareFlight

  • Ambulance
  • Grand Junction, CO
  • NPI 1164060877

  Hospital

  Care Compare affiliation
• St Mary's Hospital and Medical Center, Inc

  dba St Mary's Anticoagulation Clinic

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1619742806
  Care Compare affiliation
• St Mary's Hospital and Medical Center, Inc

  dba St Mary's Hospital & Medical Center Life Center OT/PT/SP

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1821647801
  Care Compare affiliation
• St. Mary's Hospital and Medical Center, Inc.

  dba Intermountain Health St Mary's Regional Hospital

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1699716027
  Care Compare affiliation

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

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552521600000",
    "number": "1083198659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "391 LEE BLVD STE 300",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339364973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "391 LEE BLVD STE 300",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339364973",
            "telephone_number": "239-369-4088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRIAN",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-19",
        "last_updated": "2019-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9111499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johanna Paola Iscano Valladares
• Michel Izquierdo Mendez
• Maria Padron Izquierdo
• Selena Erubi Izquierdo, REGISTERED NURSE, RN
• J Frank Avey PA (Lehigh Family Practice Associates)
• Patricia Jackson, PT
• Pauline Jackson
• Dieula Jacotin
• Michael A Jaindl, MD
• Yudit James Reyes, RBT

• Physician Assistant in Lehigh Acres, FL
• Providers in Lehigh Acres, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; 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.