Lee Sa B. Jackson, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

25793 Issued in AZ

Practice address

4824 E Baseline Rd
Suite 110
Mesa, AZ 85206-4676

Phone

(480) 615-2020

Fax

(480) 219-9957

NPI assigned

Nov 2, 2005

Sex

Female

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

Other names 1

• Lee Sa B. Baca Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Procedures performed for Medicare patients

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.

• Arizona Ophthalmology Specialists, PLC

  • Ophthalmology Physician
  • Mesa, AZ
  • NPI 1427078906
  Medicare reassignment NPD Authorized official
• Administrators of the Tulane Educational Fund

  dba Tulane University Medical Group

  • Specialist
  • New Orleans, LA
  • NPI 1528014164
  NPD (past)

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1306837042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4824 E BASELINE RD",
            "address_2": "STE 110",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064678",
            "telephone_number": "480-615-2020",
            "fax_number": "480-219-9957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4824 E BASELINE RD",
            "address_2": "SUITE 110",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064676",
            "telephone_number": "480-615-2020",
            "fax_number": "480-219-9957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LEE SA",
        "middle_name": "B.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AZ",
            "license": "25793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404731",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEE SA",
            "last_name": "BACA",
            "middle_name": "B.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Janel Jackson, LAC
• Jennifer R Jackson, LPC
• Jillian Jackson, PA
• Joshua Jackson
• Julie Jackson
• Mary Elizabeth Jackson, SLP
• Matthew Paul Jackson, D.O.
• Michael Darren Jackson, P.A.
• Randy Jackson
• Sam Jackson, LAC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.