John Calvin Jackson IV, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G37527 Issued in CA

Practice address

10565 Brunswick Rd
Ste 1
Grass Valley, CA 95945-9053

Phone

(530) 272-0501

Fax

(530) 272-0571

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

Yes

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 CA

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

Family Practice

Education

University of California, Irvine, California College of Medicine, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sierra Medical PartnershipGroup PAC ID 7810321858, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Auburn Faith Vna & Hospice Home health agency, Auburn, CA, CCN 557292
• Sutter Auburn Faith Hospital Hospital, Auburn, CA, CCN 050498

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: john.jackson.1@2545.direct.athenahealth.com
• Direct secure messaging: john.jackson.1@21842.direct.athenahealth.com

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.

• Sierra Medical Partnership

  • Surgery Physician
  • Folsom, CA
  • NPI 1568015808

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Ridge Medical Group Inc.

  • Family Medicine Physician
  • Grass Valley, CA
  • NPI 1386700649
  NPD (past) Authorized official
• Sierra Medical Partnership

  • Surgery Physician
  • El Dorado Hills, CA
  • NPI 1801502679
  NPD
• Foot and Ankle Surgeons of Northern California

  • Foot & Ankle Surgery Podiatrist
  • Grass Valley, CA
  • NPI 1427616796
  NPD (past)
• Hill Physicians Medical Group - PPO Program

  • Preferred Provider Organization
  • San Ramon, CA
  • NPI 1679011035
  NPD (past)
• Sierra Nevada Memorial-Miners Hospital

  • General Acute Care Hospital
  • Grass Valley, CA
  • NPI 1659361392
  NPD (past)
• Sutter North Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Yuba City, CA
  • NPI 1144251521
  NPD (past)
• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Sacramento, CA
  • NPI 1811946734
  NPD (past)

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

• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Auburn, CA
  • NPI 1194774299
  Care Compare affiliation
• Sutter Valley Hospitals

  • Home Health Agency
  • Auburn, CA
  • NPI 1417987751
  Care Compare affiliation

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487689840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10565 BRUNSWICK RD",
            "address_2": "STE 1",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959459053",
            "telephone_number": "530-272-0501",
            "fax_number": "530-272-0571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10565 BRUNSWICK RD",
            "address_2": "STE 1",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959459053",
            "telephone_number": "530-272-0501",
            "fax_number": "530-272-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOHN",
        "middle_name": "CALVIN",
        "name_suffix": "IV",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G37527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ian P Isbell
• Carol Ito, L.AC.
• Kim Iverson-Lee, PT
• Ivey Physical Therapy a Professional Corporation
• Kevin Dale Ivey, P.T.
• Monica Jackson, DPT
• Laura Jaco
• Jole Marie Jacobs, RN
• Ann Jacobson
• Jacquelyn Crane Jacona

• Family Medicine Physician in Grass Valley, CA
• Providers in Grass Valley, CA by specialty
• Family Medicine Physician in California

• 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.
• 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.