Active NPI
Skylar Janae Jackson
- Community Health Worker
- Vallejo, CA
National Provider Identifier
1104536119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 1116 Legend Cir
Vallejo, CA 94591-8679 - Phone
- (707) 647-3972
- NPI assigned
- Nov 30, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
1116 Legend Cir
Vallejo, CA 94591-8679
Mailing address
444 Georgia St
Vallejo, CA 94590-6005
Phone (707) 563-0157
Other practice location 1
4113 Fall Creek Ct
Fairfield, CA 94534-6637
Phone (707) 563-0157
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MSK Solutions | Current | Accepting new patients | |
| MSK Solutions | Current | Accepting new patients | |
| Progress Ranch Treatment Services for Children | Case Manager/Care Coordinator | Past | Accepting new patients |
Locations
444 Georgia St
Vallejo, CA 94590
Phone (707) 563-0157
Organizations & group practices 3
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.
-
- Foster Care Agency
- Vallejo, CA
- NPI 1265023915
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Vallejo, CA
- NPI 1437803178
-
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Sacramento, CA
- NPI 1306471420
Case Manager/Care Coordinator
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704240000000",
"number": "1104536119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "444 GEORGIA ST",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945906005",
"telephone_number": "707-563-0157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1116 LEGEND CIR",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945918679",
"telephone_number": "707-647-3972"
}
],
"practiceLocations": [
{
"address_1": "4113 Fall Creek Ct",
"address_purpose": "LOCATION",
"city": "Fairfield",
"state": "CA",
"postal_code": "945346637",
"country_code": "US",
"telephone_number": "707-563-0157",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "SKYLAR",
"middle_name": "JANAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-30",
"last_updated": "2024-01-03",
"certification_date": "2024-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.