Timothy Lawrence Jackson, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5407 Issued in AZ

Practice address

300 S 6TH St
Williams, AZ 86046-0110

Phone

(928) 635-4441

NPI assigned

Oct 19, 2010

Last updated

Jul 21, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in TX, AZ2 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

Merit-based Incentive Payment System (MIPS)

Final score

77.59 of 100Reported as group

Quality

47.51

Promoting interoperability

69

Improvement activities

40

Cost

86.96

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Tuba City Regional Health Care Corporation

  dba Tuba City Indian Medical Center

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1548294424

  TX

  Medicare reassignment
• North Country Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Show Low, AZ
  • NPI 1073740098
  NPD
• North Country Healthcare, Inc.

  • Family Medicine Physician
  • Flagstaff, AZ
  • NPI 1619345675
  NPD
• North Country Healthcare, Inc.

  dba Flagstaff Pediatric Care

  • Pediatrics Physician
  • Flagstaff, AZ
  • NPI 1669911764
  NPD
• Tuba City Regional Health Care Corporation

  dba Bodaway Gap Clinic

  • Family Medicine Physician
  • Bodaway Gap, AZ
  • NPI 1710519913
  NPD

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

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1124338504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3630",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860033630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S 6TH ST",
            "city": "WILLIAMS",
            "state": "AZ",
            "postal_code": "860460110",
            "telephone_number": "928-635-4441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2722 N Mariah Way",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "860047550",
            "country_code": "US",
            "telephone_number": "928-527-7759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIMOTHY",
        "middle_name": "LAWRENCE",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-19",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "5407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Hawks, PHARMD
• Elizabeth Dawn Haws, FNP-C
• Mary Denise Heiss, MED
• High Country Fire Rescue
• Imac Soraya Reynaga Holmes, ED.D M.S. LPC LCADC
• Kendrick O Johnson, D.O.
• Mary Jones
• Jenna Kay, MD
• Allyson Noelle Keen, PHARMD
• Linda Louise Kline, R.N.

• Medical Physician Assistant in Williams, AZ
• Providers in Williams, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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.