J Ryan Jackson, DO

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

007930 Issued in AZ

Practice address

8405 E Baseline Rd Ste 104
Mesa, AZ 85209-4376

Phone

(480) 674-3295

NPI assigned

Mar 18, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Micrographic Dermatologic Surgery (MDS)Also: Dermatology

Education

Arizona College of Osteopathic Medicine Mid Western University, 2015

Medicare assignment

May accept Medicare assignment

Group practices

La Paz Dermatology PLLCGroup PAC ID 3274066584, 2 clinicians

Fox Dermatology and Aesthetics LLCGroup PAC ID 6709304819, 3 clinicians

Az Dermatology LLCGroup PAC ID 5698850543, 19 clinicians

DL Professional Services LLCGroup PAC ID 9739597402, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

83.48 of 100Reported as group

Quality

82.26

Promoting interoperability

83

Improvement activities

40

Cost

76.85

Merit-based Incentive Payment System (MIPS)

Final score

96.63 of 100Reported as group

Quality

93.25

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: jrjackson@atozderm.emadirect.md

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.

• Az Dermatology LLC

  • Dermatology Physician
  • Mesa, AZ
  • NPI 1508035411
  Medicare reassignment Care Compare group NPD
• DL Professional Services LLC

  • Dermatology Physician
  • Mesa, AZ
  • NPI 1205422789
  Medicare reassignment Care Compare group NPD
• Fox Dermatology and Aesthetics LLC

  • Dermatology Physician
  • Mesa, AZ
  • NPI 1447051461
  Medicare reassignment Care Compare group NPD
• La Paz Dermatology PLLC

  • MOHS-Micrographic Surgery Physician
  • Queen Creek, AZ
  • NPI 1013734094

  Dermatology

  Medicare reassignment Care Compare group NPD
• La Laser Center, PC, a Professional Medical Corporation

  • Multi-Specialty Clinic/Center
  • San Clemente, CA
  • NPI 1306982855

  AZ, Dermatology

  Medicare reassignment NPD
• Az Dermatology

  • Specialist
  • Maricopa, AZ
  • NPI 1962737965
  NPD
• La Laser Center PC, a Professional Medical Corporation

  • Medical Specialty Clinic/Center
  • Gilbert, AZ
  • NPI 1619699360
  NPD
• Center for Dermatology, PLLC

  • Medical Physician Assistant
  • Scottsdale, AZ
  • NPI 1174062673
  NPD (past)
• J Robert West, M.D., Inc

  • Dermatology Physician
  • Newport Beach, CA
  • NPI 1932154788
  NPD (past)

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

{
    "created_epoch": "1426636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1346633161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8405 E BASELINE RD STE 104",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852094376",
            "telephone_number": "480-674-3295",
            "fax_number": "725-239-7974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8405 E BASELINE RD STE 104",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852094376",
            "telephone_number": "480-674-3295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "J",
        "middle_name": "RYAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-18",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "AZ",
            "license": "007930",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "007930",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casiel Dominique Jackson, LAC
• Crista Jackson
• Danielle Jackson
• Erika Jackson, MA
• J Carvel Jackson, D.O.
• Janel Jackson, LAC
• Jennifer R Jackson, LPC
• Jillian Jackson, PA
• Joshua Jackson
• Julie Jackson

• MOHS-Micrographic Surgery Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• MOHS-Micrographic Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.