Michael Darren Jackson, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1987 Issued in AZ

Practice address

6644 E. Baywood Ave.
Banner Baywood Emergency Department
Mesa, AZ 85206

Phone

(480) 321-0183

Fax

(480) 321-0402

NPI assigned

Feb 10, 2006

Last updated

Jul 23, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: smhprovider@direct.sagememorial.com

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.

• Navajo Health Foundation-Sage Memorial Hospital, Inc.

  dba Sage Memorial Physicians

  • Rural Acute Care Hospital
  • Ganado, AZ
  • NPI 1477735777
  Medicare reassignment NPD
• Emergency Physicians Southwest, PC

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1912053752
  Medicare reassignment
• Casa Grande Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Casa Grande, AZ
  • NPI 1871589051
  NPD (past)

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1154394039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 HOPYARD ROAD, SUITE 100",
            "address_2": "TEAM HEALTH, INC.",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "94588",
            "telephone_number": "800-617-7717",
            "fax_number": "304-523-2241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6644 E. BAYWOOD AVE.",
            "address_2": "BANNER BAYWOOD EMERGENCY DEPARTMENT",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85206",
            "telephone_number": "480-321-0183",
            "fax_number": "480-321-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHAEL",
        "middle_name": "DARREN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "1987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371956",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Jackson
• Julie Jackson
• Lee Sa B. Jackson, M.D.
• Mary Elizabeth Jackson, SLP
• Matthew Paul Jackson, D.O.
• Randy Jackson
• Sam Jackson, LAC
• Tahara Jackson
• Vannessa Jackson
• Willie Jackson

• Physician Assistant in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; 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.