Jackson Ross Smith, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1236209

Practice address

2620 Arbor Dr
McHenry, IL 60050-2694

Phone

(815) 385-9877

NPI assigned

Jun 9, 2025

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 IL

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

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dupage Emergency Physicians Convenient Care LLCGroup PAC ID 6608840046, 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Advocate Good Samaritan Hospital Hospital, Downers Grove, IL, CCN 140288

Medicare enrollment (NPD)

Enrolled

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.

• Dupage Emergency Physicians Convenient Care LLC

  • Emergency Medicine Physician
  • Lemont, IL
  • NPI 1922000363
  Medicare reassignment Care Compare group NPD
• Dupage Emergency Physicians LTD

  • Emergency Medicine Physician
  • Downers Grove, IL
  • NPI 1255323481
  Medicare reassignment NPD

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

• Advocate Health and Hospitals Corporation

  dba Advocate Good Samaritan Hospital

  • General Acute Care Hospital
  • Downers Grove, IL
  • NPI 1578670543
  Care Compare affiliation

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

{
    "created_epoch": "1749427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1598659963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 ARBOR DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600502694",
            "telephone_number": "815-387-9877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 ARBOR DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600502694",
            "telephone_number": "815-385-9877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACKSON",
        "middle_name": "ROSS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-06-09",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "1236209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Susan Slone, PTA WCC
• Alyssa Slusser
• Cathy Smith-Wenska, L.C.P.C., NCC
• Audra Marie Smith
• Deborah Smith
• Kristin Smith
• Lee Smith
• Marissa Star Smith
• Melissa Smith
• Melissa Smith

• Physician Assistant in McHenry, IL
• Providers in McHenry, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; 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.