Joshua Jackson

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

246232 Issued in AZ

Practice address

5432 E Southern Ave Ste 101B
Mesa, AZ 85206-2772

Phone

(480) 999-7911

NPI assigned

Aug 11, 2020

Sex

Male

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

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: joshua.jackson.1@5834.direct.athenahealth.com

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.

• Az Rehab Consultants, LLC

  dba AZ Rehab Consultants

  • Physical Medicine & Rehabilitation Physician
  • Gilbert, AZ
  • NPI 1396383402
  Medicare reassignment NPD
• Tec Emergency Physicians of Arizona, LLC

  • Emergency Care Clinic/Center
  • Gilbert, AZ
  • NPI 1245772870
  Medicare reassignment NPD

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

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1093326290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5432 E SOUTHERN AVE STE 101B",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852062772",
            "telephone_number": "480-999-7911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5432 E SOUTHERN AVE STE 101B",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852062772",
            "telephone_number": "480-999-7911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOSHUA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-11",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "246232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN NUMBER",
            "identifier": "246232",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J Carvel Jackson, D.O.
• J Ryan Jackson, DO
• Janel Jackson, LAC
• Jennifer R Jackson, LPC
• Jillian Jackson, PA
• Julie Jackson
• Lee Sa B. Jackson, M.D.
• Mary Elizabeth Jackson, SLP
• Matthew Paul Jackson, D.O.
• Michael Darren Jackson, P.A.

• Family Nurse Practitioner in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.