Individual provider Active NPI

Stequita C. Jackson, MD

  • Family Medicine Physician
  • Houston, TX
National Provider Identifier
1811480304
Registry record updated May 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
U3248 Issued in TX
Practice address
7200 Cambridge St
Houston, TX 77030-4202
Phone
(713) 798-2400
NPI assigned
Jun 11, 2018
Last updated
May 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 125.072860 IL
Adult Medicine Physician 207QA0505X U3248 TX
Adult Medicine Physician 207QA0505X 036154159 IL
Family Medicine Physician 207Q00000X U3248 TX Primary

Addresses

Primary practice location

7200 Cambridge St
Houston, TX 77030-4202

Mailing address

7200 Cambridge St
Houston, TX 77030-4202
Phone (713) 798-2400

Other practice location 1

2200 E 93rd St
Chicago, IL 60617-3905
Phone (773) 213-2190

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210910000977 IL Practitioner - Family Practice 5294070496 Reassigns benefits to 2 organizations
I20230628002227 TX Practitioner - Family Practice 5294070496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Virginia Commonwealth University, School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baylor College of MedicineGroup PAC ID 8022243971, 1,230 clinicians

Practice addresses (Care Compare)

2 Greenway PLZ
Suite 900
Houston, TX 77046-0205

3701 Kirby Dr
Houston, TX 77098-3921

7200 Cambridge St
Houston, TX 77030-4202

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036154159ILMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County Current Accepting new patients
Baylor College of Medicine CurrentSince Jun 1, 2023 Accepting new patients
Cook County Family Medicine CurrentSince Aug 19, 2021 Accepting new patients
Cook County CurrentSince Aug 19, 2021 Accepting new patients
Baylor College of Medicine Family Medicine CurrentSince Jun 1, 2023 Accepting new patients
Anointed Health Partners Limited Family Medicine CurrentSince Nov 15, 2021 Accepting new patients
Advocate Health and Hospitals Corporation PastSince Dec 1, 2021 Accepting new patients

Locations

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

2 Greenway Plz
Ste 900
Houston, TX 77046
Phone (713) 798-1835

3701 Kirby Dr
Ste 100
Houston, TX 77098
Phone (713) 798-4321

7200 Cambridge St
Houston, TX 77030
Phone (713) 798-2400

7200 Cambridge St
Fl 1
Houston, TX 77030
Phone (713) 798-3924

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IIJECA

Organizations & group practices 7

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.

Hospital & facility affiliations 1

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": "1528675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1811480304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7200 CAMBRIDGE ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304202",
            "telephone_number": "713-798-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 CAMBRIDGE ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304202",
            "telephone_number": "713-798-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 E 93rd St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606173905",
            "country_code": "US",
            "telephone_number": "773-213-2190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEQUITA",
        "middle_name": "C.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-11",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125.072860",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TX",
            "license": "U3248",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "IL",
            "license": "036154159",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "U3248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.