Sasa K Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2107 Issued in OK

Practice address

1400 SE 4TH St
Ste H
Moore, OK 73160-7329

Phone

(405) 799-7400

Fax

(405) 799-7405

NPI assigned

Jan 20, 2012

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

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Emergency Physicians of Mid-America, P.C.

  • Emergency Medicine Physician
  • Oklahoma City, OK
  • NPI 1063825297
  Medicare reassignment
• Oklahoma Emergency Services PC

  • Emergency Medicine Physician
  • Lawton, OK
  • NPI 1114239795
  Medicare reassignment
• Moore Primary Care Inc

  • Family Medicine Physician
  • Moore, OK
  • NPI 1063536233
  NPD (past)
• SSM Health Care of Oklahoma, Inc.

  dba SSM Health St. Anthony Hospital - Oklahoma City

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1366545311
  NPD (past)

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

{
    "created_epoch": "1327017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1447521539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 SE 4TH ST",
            "address_2": "STE H",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731607329",
            "telephone_number": "405-799-7400",
            "fax_number": "405-799-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 SE 4TH ST",
            "address_2": "STE H",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731607329",
            "telephone_number": "405-799-7400",
            "fax_number": "405-799-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SASA",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-20",
        "last_updated": "2012-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackalope Therapy
• Amy Estelle Jackson, P.T.
• Jessica Elise Jackson, PA-C
• Keri Lee Jackson, PT
• Kylee Jackson, MED, ATC, LAT
• Madeleine Jacobs, PT, DPT
• Megan R Jacobson, MD
• Chris Winny James, DO
• Lindsay Lea James, LCSW
• Rebyl James, MSN, APRN, FNP-C

• Physician Assistant in Moore, OK
• Providers in Moore, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; 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.