Michael E Jackson, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

10306 Issued in NV

Practice address

11103 Kilkerran CT
Las Vegas, NV 89141-4356

Phone

(702) 614-4576

Fax

(702) 614-4576

NPI assigned

Nov 16, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, TX2 enrollments

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 2

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.

• Bisbee Hospital Association

  • Critical Access Hospital
  • Bisbee, AZ
  • NPI 1518968767
  Medicare reassignment NPD
• Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm

  • Public Health or Welfare Agency
  • Phoenix, AZ
  • NPI 1083643738

  TX

  Medicare reassignment NPD
• Emergency Group of Arizona Professional Corporation

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1215275433
  Medicare reassignment NPD
• Jackson Health and Theater

  • Emergency Medicine Physician
  • Pahrump, NV
  • NPI 1548201635
  NPD (past) Authorized official
• Bisbee Hospital Association

  • Rural Health Clinic/Center
  • Hereford, AZ
  • NPI 1245986975
  NPD
• Bisbee Hospital Association

  • Clinic/Center
  • Bisbee, AZ
  • NPI 1568471696
  NPD
• Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm

  • Public Health or Welfare Agency
  • Maricopa, AZ
  • NPI 1538043443
  NPD
• Lake Mead Emergency Physicians, LLC

  • Emergency Medicine Physician
  • N Las Vegas, NV
  • NPI 1154367605
  NPD (past)
• Nopah Vista Emergency Physicians LLC

  • Emergency Medicine Physician
  • Pahrump, NV
  • NPI 1396794095
  NPD (past)
• Chase Dennis Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Santa Rosa, CA
  • NPI 1033152350
  NPD (past)
• Emcare Physician Providers, Inc

  • Emergency Medicine Physician
  • Winslow, AZ
  • NPI 1144270315
  NPD (past)
• Emcare Physician Providers, Inc

  • Emergency Medicine Physician
  • Parker, AZ
  • NPI 1821048927
  NPD (past)

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437131331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11103 KILKERRAN CT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891414356",
            "telephone_number": "702-614-4576",
            "fax_number": "702-614-4576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11103 KILKERRAN CT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891414356",
            "telephone_number": "702-614-4576",
            "fax_number": "702-614-4576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHAEL",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NV",
            "license": "10306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Master Jackson
• Matthew Curtis Jackson Jr.
• Meldajah Earlnisha Nedevore Jackson
• Micaela Jackson
• Michael Jackson
• Mieishia Jackson
• Minette Jackson
• Myonna Jackson
• Nichole Jackson
• Nikita Jackson

• Emergency Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Emergency Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.