Renae Jackson

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

A193442 Issued in CA

Practice address

25460 Medical Center Drive, Suite 100
Murrieta, CA 92562

Phone

(951) 677-4748

NPI assigned

Mar 26, 2020

Last updated

Oct 29, 2024By the provider in NPPES

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 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

Obstetrics/Gynecology

Education

Loma Linda University School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rancho Family Medical Group IncGroup PAC ID 6305741240, 112 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: rjackson150336@direct.llu.edu

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.

• Rancho Family Medical Group, Inc.

  dba Platinum Women's Health and Wellness

  • Family Medicine Physician
  • Temecula, CA
  • NPI 1598791600

  Obstetrics & Gynecology

  Medicare reassignment Care Compare group NPD
• Rincon Health Network

  • Health Service Clinic/Center
  • Temecula, CA
  • NPI 1902697832
  NPD (past)
• UC San Diego Health - Rancho Family Medical Group

  • Multi-Specialty Clinic/Center
  • Temecula, CA
  • NPI 1003385071
  NPD (past)

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

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1629605746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25460 MEDICAL CENTER DRIVE",
            "address_2": "STE 100",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "92562",
            "telephone_number": "951-677-4748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25460 MEDICAL CENTER DRIVE, SUITE 100",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "92562",
            "telephone_number": "951-677-4748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RENAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-26",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A193442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson and Lee Dental Corporation (Plaza Dental Group)
• Antoinette S Jackson-Sekunda, NP
• Amari Jackson
• Lester Jackson
• Olga R Jackson, FNP-BC, PMHNP-BC
• Seana Alyssa Jackson
• Tatianna D Jackson
• William W Jackson, M.D.
• Natalie Jacobo
• Robert Jacobs

• Obstetrics & Gynecology Physician in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; 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.