Michelle Laporte Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA0007793 Issued in CO

Practice address

2880 Monroe Ave
Loveland, CO 80538-3274

Phone

(970) 613-6800

Fax

(970) 613-6801

NPI assigned

Aug 17, 2015

Last updated

Feb 9, 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 CO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michelle.jackson.1@27043.direct.athenahealth.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.

• Sunrise Community Health

  dba Loveland Community Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Loveland, CO
  • NPI 1902005382
  Medicare reassignment
• Sunrise Community Health

  dba North Loveland Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Loveland, CO
  • NPI 1700690252
  NPD
• Sunrise Community Health

  dba Kid's Care Clinic

  • Federally Qualified Health Center (FQHC)
  • Evans, CO
  • NPI 1811295264
  NPD
• Sunrise Community Health

  dba Sunrise Thompson Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Loveland, CO
  • NPI 1043937576
  NPD (past)
• Adeteju Ogunrinde, MD, F.a.a.P., Children's Health Care Ctr.

  dba Children's Healthcare Center

  • Pediatrics Physician
  • Waldorf, MD
  • NPI 1548544992
  NPD (past)

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

{
    "created_epoch": "1439769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1679949416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 11TH AVE",
            "city": "EVANS",
            "state": "CO",
            "postal_code": "806201011",
            "telephone_number": "970-350-4606",
            "fax_number": "970-350-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2880 MONROE AVE",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805383274",
            "telephone_number": "970-613-6800",
            "fax_number": "970-613-6801"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "605 Post Office Rd",
            "address_2": "Suite 102",
            "address_purpose": "LOCATION",
            "city": "Waldorf",
            "state": "MD",
            "postal_code": "206021913",
            "country_code": "US",
            "telephone_number": "301-374-2666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHELLE",
        "middle_name": "LAPORTE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-17",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA0007793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isco, Inc
• Island Grove Regional Treatment Center
• It's Me Again of Colorado, Inc
• Heather Jackson, M.A.
• Madelyn Jackson
• Joseph P Jacob, MD
• Katherine Ann Jacob, PT, DPT
• Prema M Jacob, MD
• Kathleen M Jacober, MSW
• Erin Jacobs, MS, LMFT

• Physician Assistant in Loveland, CO
• Providers in Loveland, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.