NPIMap

Individual provider Active NPI

Shaun William Jackson, MD

  • Pediatric Nephrology Physician
  • Seattle, WA
National Provider Identifier
1780845818
Registry record updated Jun 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
License
MD60002199 Issued in WA
Practice address
4800 Sand Point Way NE
Seattle Children'S Hospital, Division of Nephrology
Seattle, WA 98105
Phone
(857) 891-6790
NPI assigned
Jun 20, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 225159 MA
Pediatric Rheumatology Physician 2080P0216X MD60002199 WA
Pediatric Nephrology Physician 2080P0210X MD60002199 WA Primary

Addresses

Primary practice location

4800 Sand Point Way NE
Seattle Children'S Hospital, Division of Nephrology
Seattle, WA 98105

Mailing address

4800 Sand Point Way NE
Seattle Children'S Hospital, Division of Nephrology
Seattle, WA 98105-3901
Phone (857) 891-6790

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120820001006 WA Practitioner - Pediatric MedicinePractitioner - NephrologyPractitioner - Rheumatology 8224285648 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Nephrology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4800 Sand Point Way NE
Seattle, WA 98105-3901
Phone (206) 526-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
225159MAMDClinical Social Worker
MD60002199WAMDPediatric Nephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Nov 10, 2021 Accepting new patients
Multicare Health System CurrentSince Nov 10, 2021 Accepting new patients
The Association of Chrmc and University Physicians Pediatrics CurrentSince Jul 1, 2012 Accepting new patients
Association of CHMC and University Physicians Pediatrics CurrentSince Jul 1, 2012 Accepting new patients
Multicare Health System Current Accepting new patients
Seattle Children'S Hospital Past Accepting new patients

Locations

900 Pacific Ave
Ste 100
Everett, WA 98201
Phone (425) 304-6080

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

200 Lilly Rd NE
Ste C
Olympia, WA 98506
Phone (360) 918-8336

4800 Sand Point Way NE
Seattle, WA 98105
Phone (206) 526-2000

317 Martin Luther King Jr Way
Tacoma, WA 98405
Phone (253) 403-1400

Interoperability endpoints

  • Direct secure messaging: sjackson5510@direct.seattlechildrens.org

Organizations & group practices 6

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530057600000",
    "number": "1780845818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 SAND POINT WAY NE",
            "address_2": "SEATTLE CHILDREN'S HOSPITAL, DIVISION OF NEPHROLOGY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981053901",
            "telephone_number": "857-891-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 SAND POINT WAY NE",
            "address_2": "SEATTLE CHILDREN'S HOSPITAL, DIVISION OF NEPHROLOGY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98105",
            "telephone_number": "857-891-6790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHAUN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-20",
        "last_updated": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "225159",
            "primary": false
        },
        {
            "code": "2080P0216X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Rheumatology",
            "state": "WA",
            "license": "MD60002199",
            "primary": false
        },
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "WA",
            "license": "MD60002199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.