Keith Wayne Jackson, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

G46539 Issued in CA

Practice address

235 N Hoover St
Los Angeles, CA 90004-3627

Phone

(949) 707-5339

NPI assigned

Mar 5, 2007

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

Other identifiers 1

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

Anesthesiology

Education

Johns Hopkins University School of Medicine, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orange Coast Anesthesia IncGroup PAC ID 2466613591, 85 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uci Health-Orange Hospital, Orange, CA, CCN 050348

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.

• Orange Coast Anesthesia Inc

  • Anesthesiology Physician
  • Orange, CA
  • NPI 1508138256
  Medicare reassignment Care Compare group NPD
• Premiercare Anesthesia Fountain Valley Inc

  • Anesthesiology Physician
  • Fountain Valley, CA
  • NPI 1831536531
  Medicare reassignment NPD

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

• University of California Irvine

  dba University of California Irvine - Cac Urgent Care

  • Urgent Care Clinic/Center
  • Irvine, CA
  • NPI 1518739309

  Hospital

  Care Compare affiliation
• University of California Irvine

  dba Uci Health

  • General Acute Care Hospital
  • Orange, CA
  • NPI 1689608150
  Care Compare affiliation

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548399538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25108 MARGUERITE PKWY",
            "address_2": "SUITE A 203",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926922400",
            "telephone_number": "949-707-5339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 N HOOVER ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900043627",
            "telephone_number": "949-707-5339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KEITH",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G46539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G465391",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joyce Jackson
• Jua Jackson
• Kanika Jackson
• Katrice Jewelean Jackson, LCSW
• Keith Lopez Jackson
• Kevin Jackson
• Kiyunda Renee Nicole Jackson
• La Doris Jackson
• La Toya Jackson
• Ladale B Jackson II

• Anesthesiology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Anesthesiology 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.