Michelle Laporte Jackson, PA-C
Individual provider Active NPI Physician Assistant · Loveland, CO
NPI 1679949416 · NPPES record last updated Feb 9, 2024
Key facts
- NPI
- 1679949416
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA0007793 (CO)
- Practice address
- 2880 Monroe Ave
Loveland, CO 80538-3274 - Phone
- (970) 613-6800
- Fax
- (970) 613-6801
- NPI assigned
- Aug 17, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240313001435 | CO | Practitioner - Physician Assistant | 3779929781 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA0007793 | CO | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunrise Community Health | Current |
Accepting new patients | |
| Adeteju Ogunrinde, MD, F.a.a.P., Children'S Health Care Ctr. | Past | Accepting new patients | |
| Sunrise Community Health | Past | Accepting new patients | |
| Sunrise Community Health | Past | Accepting new patients |
Locations
2930 11th Ave
Evans, CO 80620
Phone (970) 350-4606
302 3rd St SE
Ste 150
Loveland, CO 80537
Phone (970) 669-4855
Interoperability endpoints
- michelle.jackson.1@27043.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA0007793 | CO | Yes |
Addresses
Primary practice location
2880 Monroe Ave
Loveland, CO 80538-3274
Mailing address
2930 11TH Ave
Evans, CO 80620-1011
Phone (970) 350-4606
Other practice location 1
605 Post Office Rd
Suite 102
Waldorf, MD 20602-1913
Phone (301) 374-2666
Other providers in Loveland, CO
- Isco, Inc
- Island Grove Regional Treatment Center
- It'S Me Again of Colorado, Inc
- Heather Jackson
- Madelyn Jackson
- Joseph P Jacob
- Katherine Ann Jacob
- Prema M Jacob
- Kathleen M Jacober
- Erin Jacobs
All providers in Loveland, CO · Physician Assistant in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.