Active NPI
Michelene Jackson, PA
- Physician Assistant
- Aurora, CO
National Provider Identifier
1679565394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA.0000444
- Practice address
- 3292 Peoria St
Aurora, CO 80010-1517 - Phone
- (303) 360-6276
- Fax
- (303) 467-5355
- NPI assigned
- Aug 18, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA.0000444 | CO | Primary |
Addresses
Primary practice location
3292 Peoria St
Aurora, CO 80010-1517
Mailing address
3701 S Broadway
Englewood, CO 80113-3611
Phone (303) 360-6276
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA.0000444 | CO | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gemini Medical Group Inc | Past | Accepting new patients | |
| St. John Physicians, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Bartlesville, OK
- NPI 1821052473
-
- Internal Medicine Physician
- Tulsa, OK
- NPI 1336194406
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460419200000",
"number": "1679565394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3701 S BROADWAY",
"city": "ENGLEWOOD",
"state": "CO",
"postal_code": "801133611",
"telephone_number": "303-360-6276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3292 PEORIA ST",
"city": "AURORA",
"state": "CO",
"postal_code": "800101517",
"telephone_number": "303-360-6276",
"fax_number": "303-467-5355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHELENE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-18",
"last_updated": "2016-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "PA.0000444",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.