Theresa Jackson, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

32423 Issued in OK

Practice address

4629 E 13TH PL
Tulsa, OK 74112-6103

Phone

(405) 822-8297

NPI assigned

Apr 8, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of Oklahoma College of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Las Cruces Physician Practices, LLCGroup PAC ID 7618974858, 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Medical Center Hospital, Las Cruces, NM, CCN 320018

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: theresa.jackson.1@19849.direct.athenahealth.com

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.

• Las Cruces Physician Practices, LLC

  • Vascular Surgery Physician
  • Las Cruces, NM
  • NPI 1093947491
  Medicare reassignment Care Compare group NPD
• Las Cruces Physician Practices, LLC

  • Cardiovascular Disease Physician
  • Las Cruces, NM
  • NPI 1346586195
  NPD
• Las Cruces Physician Practices, LLC

  • Family Medicine Physician
  • Las Cruces, NM
  • NPI 1356390769
  NPD
• PHC-Las Cruces Inc

  • General Acute Care Hospital
  • Las Cruces, NM
  • NPI 1700821808
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• PHC-Las Cruces Inc

  • General Acute Care Hospital
  • Las Cruces, NM
  • NPI 1700821808
  Care Compare affiliation

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

{
    "created_epoch": "1428451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1164818993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4629 E 13TH PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741126103",
            "telephone_number": "405-822-8297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4629 E 13TH PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741126103",
            "telephone_number": "405-822-8297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "THERESA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-08",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "BP10052439",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "32423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "6600 Bruceville Rd",
            "city": "Sacramento",
            "state": "CA",
            "country_code": "US",
            "postal_code": "958234671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sondra P Jackson
• Tanya Kaye Jackson, DPT
• Tawonna Jackson
• Teagan Dawn Jackson
• Terik Jackson
• Theresa Diann Jackson
• Tonya Ward Jackson, O.D
• William L Jackson Jr., MD
• William Landon Jackson, DO
• Andrew Nathan Jacob

• Emergency Medicine Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Emergency Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.