Shawn Ian Jackson, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

04-33385 Issued in KS

Practice address

1947 N Founders Cir
Wcgme
Wichita, KS 67206-3548

Phone

(316) 613-4930

NPI assigned

Jun 15, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mid-Continent Anesthesiology Chartered

  • Anesthesiology Physician
  • Wichita, KS
  • NPI 1699750273
  Medicare reassignment NPD
• Lawrence Anaesthesia PA

  • Pain Medicine (Anesthesiology) Physician
  • Lawrence, KS
  • NPI 1487618229
  Medicare reassignment
• Ascension Via Christi Hospitals Wichita Inc.

  dba Ascension Via Christi Physician Group

  • Family Medicine Physician
  • Wichita, KS
  • NPI 1871589333
  NPD (past)

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

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417392000000",
    "number": "1609071158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1947 N FOUNDERS CIR",
            "address_2": "WCGME",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063548",
            "telephone_number": "316-613-4930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1947 N FOUNDERS CIR",
            "address_2": "WCGME",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063548",
            "telephone_number": "316-613-4930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHAWN",
        "middle_name": "IAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-15",
        "last_updated": "2014-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KS",
            "license": "04-33385",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "04-33385",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200656050A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corey Jackson, D.P.T.
• Hannah Isabelle Piros Jackson, LMLP
• Matthew DV Jackson, DDS
• Megan J Jackson, RN
• Renee Jackson, RN, BSN
• Jacob Kresky LLC
• Constance Jacob, APRN
• Joel Jacob, MD
• Nathan Jacobberger
• Amy Marie Jacobs, LMLP LCP

• Anesthesiology Physician in Wichita, KS
• Providers in Wichita, KS by specialty
• Anesthesiology Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2014; 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.