Active NPI
Sam Jackson, M.D.
- Emergency Medicine Physician
- Phoenix, AZ
National Provider Identifier
1083812366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 35554
- Practice address
- 925 E McDowell Rd
Floor 2
Phoenix, AZ 85006-2502 - Phone
- (602) 239-2280
- Fax
- (602) 239-4138
- NPI assigned
- Jul 6, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 35554 | AZ | Primary |
| Medical Toxicology (Emergency Medicine) Physician | 207PT0002X | 77351 | AZ |
Addresses
Primary practice location
925 E McDowell Rd
Floor 2
Phoenix, AZ 85006-2502
Mailing address
925 E McDowell Rd
Floor 2
Phoenix, AZ 85006-2502
Phone (602) 239-2280
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35554 | AZ | MD | Emergency Medicine Physician |
| 77351 | AZ | MD | Medical Toxicology (Emergency Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1083812366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 E MCDOWELL RD",
"address_2": "FLOOR 2",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062502",
"telephone_number": "602-239-2280",
"fax_number": "602-239-4138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 E MCDOWELL RD",
"address_2": "FLOOR 2",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062502",
"telephone_number": "602-239-2280",
"fax_number": "602-239-4138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SAM",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-06",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "AZ",
"license": "35554",
"primary": true
},
{
"code": "207PT0002X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Medical Toxicology",
"state": "AZ",
"license": "77351",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.