Marilyn Orio Jackson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

13164 Issued in CA

Practice address

41715 Winchester Rd
Suite 204
Temecula, CA 92590-4808

Phone

(951) 719-1414

Fax

(951) 719-3158

NPI assigned

Nov 14, 2006

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

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: marilyn.jackson@nh.eclinicaldirectplus.com

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323993600000",
    "number": "1699847913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26577 CORTE EMPRESA",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "92590",
            "telephone_number": "951-587-6065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41715 WINCHESTER RD",
            "address_2": "SUITE 204",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925904808",
            "telephone_number": "951-719-1414",
            "fax_number": "951-719-3158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARILYN",
        "middle_name": "ORIO",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2011-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "13164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RN288619",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anita Cal Jackson, M.D.
• Eliana Jackson
• Jasmine Jackson, LMFT
• Joan Jackson
• Laura Jackson
• Maryanne Kismet Jackson
• Tiffany Jackson, HIS
• Jacob Chae DMD Inc (Town Center Dental)
• Jacob Hall, M.D., Inc.
• Kaila Jacobs, RBT

• Family Nurse Practitioner in Temecula, CA
• Providers in Temecula, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; 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.