Timothy Lawrence Jackson, PA
Individual provider Active NPI Medical Physician Assistant · Williams, AZ
NPI 1124338504 · NPPES record last updated Jul 21, 2021
Key facts
- NPI
- 1124338504
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 5407 (AZ)
- Practice address
- 300 S 6TH St
Williams, AZ 86046-0110 - Phone
- (928) 635-4441
- NPI assigned
- Oct 19, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 77.59 of 100
- Quality
- 47.51
- Promoting interoperability
- 69
- Improvement activities
- 40
- Cost
- 86.96
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110103000130 | TX | Practitioner - Physician Assistant | 1658569959 | Reassigns benefits to 1 organization |
| I20130805000444 | AZ | Practitioner - Physician Assistant | 1658569959 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5407 | AZ | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Country Healthcare, Inc. | Current |
Accepting new patients | |
| Tuba City Regional Health Care Corporation | Current |
Accepting new patients | |
| Tuba City Regional Health Care Corporation | Current |
Accepting new patients | |
| North Country Healthcare, Inc. | Current | Accepting new patients | |
| North Country Healthcare, Inc. | Current |
Accepting new patients |
Locations
301 S 7th St
Williams, AZ 86046
Phone (928) 380-2611
300 S 6th St
Williams, AZ 86046
Phone (928) 635-4441
620 Lee St
Winslow, AZ 86047
Phone (928) 288-8700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5407 | AZ | Yes |
Addresses
Primary practice location
300 S 6TH St
Williams, AZ 86046-0110
Mailing address
PO Box 3630
Flagstaff, AZ 86003-3630
Other practice location 1
2722 N Mariah Way
Flagstaff, AZ 86004-7550
Phone (928) 527-7759
Other providers in Williams, AZ
- Theresa Hawks
- Elizabeth Dawn Haws
- Mary Denise Heiss
- High Country Fire Rescue
- Imac Soraya Reynaga Holmes
- Kendrick O Johnson
- Mary Jones
- Jenna Kay
- Allyson Noelle Keen
- Linda Louise Kline
All providers in Williams, AZ · Medical Physician Assistant in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.