Lance Elliot Jackson, M.D., F.A.C.S.

Primary specialty

Otology & Neurotology PhysicianTaxonomy code 207YX0901X

License

L5777 Issued in TX

Practice address

18518 Hardy Oak
Suite 300
San Antonio, TX 78258-4271

Phone

(210) 696-4327

Fax

(210) 798-2509

NPI assigned

Jul 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in TX

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

Otolaryngology

Education

Washington University School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ear Institute of Texas P aGroup PAC ID 5991800310, 12 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

86.86 of 100Reported as individual

Quality

73.71

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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 and National Provider Directory roles.

• Ear Institute of Texas P a

  • Specialist
  • San Antonio, TX
  • NPI 1093846248
  Medicare reassignment Care Compare group NPD Authorized official
• Granite Anesthesia

  dba Granite Clinical Services

  • Clinical Neurophysiology Physician
  • San Antonio, TX
  • NPI 1548773203
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359072000000",
    "number": "1174554521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18518 HARDY OAK",
            "address_2": "SUITE 300",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584271",
            "telephone_number": "210-696-4327",
            "fax_number": "210-798-2509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18518 HARDY OAK",
            "address_2": "SUITE 300",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584271",
            "telephone_number": "210-696-4327",
            "fax_number": "210-798-2509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LANCE",
        "middle_name": "ELLIOT",
        "name_prefix": "Dr.",
        "credential": "M.D., F.A.C.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2013-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "L5777",
            "primary": false
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "TX",
            "license": "L5777",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "L5777",
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "TX",
            "license": "L5777",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00019999",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157518501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7047136",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "8H5000",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMP",
            "identifier": "MDL5777",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Jackson, LVN
• Kathy Jackson
• Kelci Jackson
• Krystal Nicole Jackson, LMT, CHHP
• Lacey Janee Jackson
• Learrionn Chanae Jackson, LVN
• Lindsey Jackson, LPC
• Loria Janelle Jackson
• Marlischa Jackson
• Megan D Jackson, APRN FNP-C

• Otology & Neurotology Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Otology & Neurotology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.
• 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.