Active NPI
Steven Bryce Jackson
- Basic Emergency Medical Technician
- Fresno, CA
National Provider Identifier
1104581024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Basic Emergency Medical Technician
- License
- E161521
- Practice address
- 900 W Belgravia Ave
Fresno, CA 93706-3909 - Phone
- (559) 265-2045
- NPI assigned
- Nov 4, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Basic Emergency Medical Technician | 146N00000X | E161521 | CA | Primary |
Addresses
Primary practice location
900 W Belgravia Ave
Fresno, CA 93706-3909
Mailing address
900 W Belgravia Ave
Fresno, CA 93706-3909
Phone (559) 265-2045
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E161521 | CA | MD | Basic Emergency Medical Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635984000000",
"number": "1104581024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 W BELGRAVIA AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937063909",
"telephone_number": "559-265-2045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 W BELGRAVIA AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937063909",
"telephone_number": "559-265-2045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "STEVEN",
"middle_name": "BRYCE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-11-04",
"last_updated": "2021-11-04",
"certification_date": "2021-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "CA",
"license": "E161521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.