Janette Lee Jackson, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

16118 Issued in CA

Practice address

2618 South Western Avenue
Los Angeles, CA 90018

Phone

(323) 730-9000

Fax

(323) 730-4825

NPI assigned

May 1, 2007

Last updated

Oct 15, 2019By 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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Camarena HealthGroup PAC ID 4880584317, 79 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Elizabeth Community Hospital Hospital, Red Bluff, CA, CCN 050042

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: janette.jacksonnpl.p1@direct.jwch.nextgenshare.com
• Direct secure messaging: jxj110pcs@m541.primeclinicalsystems.direct-ci.com

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.

• Camarena Health

  • Federally Qualified Health Center (FQHC)
  • Madera, CA
  • NPI 1891778114
  Medicare reassignment Care Compare group
• Camarena Health

  dba Camarena Health - Los Banos

  • Federally Qualified Health Center (FQHC)
  • Los Banos, CA
  • NPI 1114757754
  NPD
• Camarena Health

  dba Camarena Health -Almond Campus Urgent Care

  • Urgent Care Clinic/Center
  • Madera, CA
  • NPI 1568120723
  NPD
• Ronald Seymour Weaver MD Inc

  • Specialist
  • Los Angeles, CA
  • NPI 1730430588
  NPD (past)
• Ronald Seymour Weaver MD Inc.

  • Specialist
  • Inglewood, CA
  • NPI 1336354315
  NPD (past)

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

• Dignity Health

  dba St. Elizabeth Community Hospital

  • General Acute Care Hospital
  • Red Bluff, CA
  • NPI 1083732853
  Care Compare affiliation
• Dignity Health

  dba Dignity Health Solano Street Medical Clinic

  • Rural Health Clinic/Center
  • Corning, CA
  • NPI 1609246461

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571097600000",
    "number": "1639390578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 N D ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011109",
            "telephone_number": "909-708-8158",
            "fax_number": "909-380-7030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2618 SOUTH WESTERN AVENUE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90018",
            "telephone_number": "323-730-9000",
            "fax_number": "323-730-4825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JANETTE",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2019-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "16118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory David Jackson Sr.
• Harold Jackson
• Jacari Da Von Jackson
• Jahlaina Jackson, ASW, PPSC
• Jan Lindsey Jackson, LMSW
• Janice Jackson
• Jasiya Jackson
• Jasmine Renee Jackson
• Jatoya Jackson
• Jennifer Jackson, LCSW

• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2019; 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.