Individual provider Active NPI

Joel Jackson

  • Certified Registered Nurse Anesthetist
  • Sacramento, CA
National Provider Identifier
1366281826
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APRN.CRNA.0021045 Issued in OH
Practice address
4301 X Street
Sacramento, CA 95817
Phone
(419) 953-4775
NPI assigned
May 23, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X APRN.CRNA.0021045 OH Primary

Addresses

Primary practice location

4301 X Street
Sacramento, CA 95817

Mailing address

4012 San Marino St
Dayton, OH 45440
Phone (419) 953-4775

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240913001105 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3678013877 Reassigns benefits to 1 organization
I20240918004733 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 3678013877 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PHS Anesthesia Billing, LLCGroup PAC ID 2264958412, 241 clinicians
Regents of the Univ of CaGroup PAC ID 3375456619, 1,571 clinicians

Practice addresses (Care Compare)

1 Wyoming St
Dayton, OH 45409-2722
Phone (937) 208-8000

2315 Stockton Blvd
Sacramento, CA 95817-2201
Phone (916) 734-2011

4860 Y St
Sacramento, CA 95817-2307

4861 Y St
Sacramento, CA 95817-2307
Phone (916) 734-2525

4868 X St
Sacramento, CA 95817-2205

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN.CRNA.0021045OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca CurrentSince Sep 1, 2024 Accepting new patients
PHS Anesthesia Billing, LLC CurrentSince Sep 15, 2025 Accepting new patients
Regents of the Univ of Ca Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2024 Accepting new patients
Anesthesiology Services Network LTD CurrentSince Jul 17, 2024 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients

Locations

10850 White Rock Rd
Rancho Cordova, CA 95670

2315 Stockton Blvd
Sacramento, CA 95817
Phone (916) 703-3030

2315 Stockton Blvd
Ste 1200
Sacramento, CA 95817
Phone (916) 734-5394

4301 X St
Sacramento, CA 95817
Phone (800) 282-3284

4860 Y St
Sacramento, CA 95817
Phone (916) 734-2700

1 Wyoming St
Dayton, OH 45409
Phone (937) 208-2636

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1716422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1366281826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4012 SAN MARINO ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45440",
            "telephone_number": "419-953-4775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 X STREET",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95817",
            "telephone_number": "419-953-4775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-23",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "APRN.CRNA.0021045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.