Active NPI
Paul Jackson
- Peer Specialist
- Riverside, CA
National Provider Identifier
1215235866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 9890 County Farm Rd Ste 2
Riverside, CA 92503 - Phone
- (951) 509-2499
- NPI assigned
- Mar 7, 2011
- Last updated
- Apr 24, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | CA | Primary |
Addresses
Primary practice location
9890 County Farm Rd Ste 2
Riverside, CA 92503
Mailing address
9825 Magnolia Ave Ste B
Riverside, CA 92503-3565
Other practice location 1
620 N Ash St
Escondido, CA 92027-1902
Phone (760) 741-7708 ext. 203
Other practice location 2
620 N Ash St
Escondido, CA 92027-1902
Phone (760) 741-7708 ext. 203
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556064000000",
"number": "1215235866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9825 MAGNOLIA AVE STE B",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925033565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9890 COUNTY FARM RD STE 2",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "92503",
"telephone_number": "951-509-2499"
}
],
"practiceLocations": [
{
"address_1": "620 N Ash St",
"address_purpose": "LOCATION",
"city": "Escondido",
"state": "CA",
"postal_code": "920271902",
"country_code": "US",
"telephone_number": "760-741-7708 x203",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "620 N Ash St",
"address_purpose": "LOCATION",
"city": "Escondido",
"state": "CA",
"postal_code": "920271902",
"country_code": "US",
"telephone_number": "760-741-7708 x203",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "PAUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-07",
"last_updated": "2019-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.