Individual provider Active NPI

Shayla Jackson, PA-C

  • Physician Assistant
  • Mars, PA
National Provider Identifier
1679824064
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA055773 Issued in PA
Practice address
6998 Crider Rd
Mars, PA 16046
Phone
(724) 778-3627
NPI assigned
Sep 25, 2012
Last updated
May 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085-011019 IL
Physician Assistant 363A00000X MA055773 PA Primary
Medical Physician Assistant 363AM0700X MA055773 PA

Addresses

Primary practice location

6998 Crider Rd
Mars, PA 16046

Mailing address

5200 Centre Ave Ste 715
Pittsburgh, PA 15232-1327

Other practice location 1

5200 Centre Ave Ste 715
Pittsburgh, PA 15232-1327
Phone (412) 864-7521

Other practice location 2

14555 W National Ave
New Berlin, WI 53151-4494
Phone (262) 693-4312

Other practice location 3

1441 Branding Ave Ste 310
Downers Grove, IL 60515-5624
Phone (708) 634-0950

Other identifiers 1

IdentifierTypeStateIssuer
100316099MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address sjackson425772@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, WI, IL, GA4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20220520000905 NC Practitioner - Physician Assistant 5890945810 Reassigns benefits to 3 organizations
I20250416001526 WI Practitioner - Physician Assistant 5890945810 Reassigns benefits to 1 organization
I20250512003125 IL Practitioner - Physician Assistant 5890945810 Reassigns benefits to 1 organization
I20251027002567 GA Practitioner - Physician Assistant 5890945810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

420 E 2ND Ave
Suite 103
Rome, GA 30161-3210

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-011019ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Mar 2, 2024 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jun 6, 2022 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Mar 7, 2025 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jun 6, 2022 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Apr 1, 2025 Accepting new patients
Floyd Healthcare Management Inc CurrentSince Sep 1, 2025 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Mar 7, 2025 Accepting new patients
Floyd Healthcare Management Inc Physician Assistant CurrentSince Sep 1, 2025 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

1025 N Main St
Cedartown, GA 30125
Phone (770) 748-5212

990 Veterans Memorial Hwy NE
#A
Rome, GA 30161
Phone (706) 291-4100

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

1441 Branding Ave
Ste 310
Downers Grove, IL 60515
Phone (630) 829-1038

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

5717 Albemarle Rd
Charlotte, NC 28212
Phone (704) 563-2150

9332 S Tryon St
Charlotte, NC 28273
Phone (704) 587-6700

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

Interoperability endpoints

  • Direct secure messaging: sjackson425772@direct.myadvocateaurora.org
  • Direct secure messaging: sjackson905589@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1348531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1679824064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 CENTRE AVE STE 715",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152321327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6998 CRIDER RD",
            "city": "MARS",
            "state": "PA",
            "postal_code": "16046",
            "telephone_number": "724-778-3627"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5200 Centre Ave Ste 715",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152321327",
            "country_code": "US",
            "telephone_number": "412-864-7521",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14555 W National Ave",
            "address_purpose": "LOCATION",
            "city": "New Berlin",
            "state": "WI",
            "postal_code": "531514494",
            "country_code": "US",
            "telephone_number": "262-693-4312",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1441 Branding Ave Ste 310",
            "address_purpose": "LOCATION",
            "city": "Downers Grove",
            "state": "IL",
            "postal_code": "605155624",
            "country_code": "US",
            "telephone_number": "708-634-0950",
            "fax_number": "708-634-0942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHAYLA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-25",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-011019",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA055773",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA055773",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100316099",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sjackson425772@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1441 Branding Ave Ste 310",
            "city": "Downers Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605155624",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1441 Branding Ave Ste 310",
            "city": "Downers Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605155624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mars, PA

Sources for this page

Verify at the official NPI Registry.