Amanda Sue Jackson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A91439 Issued in CA

Practice address

850 5TH St
Gonzales, CA 93926-9491

Phone

(831) 675-3601

NPI assigned

Aug 5, 2006

Last updated

Jan 14, 2025By 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 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, WI2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: admin@soledadmedicalclinic.e-mdsdirect.com
• Direct secure messaging: ajackson19218@direct.svmh.com
• Direct secure messaging: amanda-jackson@soledadmedicalclinic.e-mdsdirect.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.

• Salinas Valley Memorial Healthcare System

  dba Taylor Farms Family Health & Wellness Center

  • Rural Health Clinic/Center
  • Gonzales, CA
  • NPI 1437549284
  Medicare reassignment NPD
• Svmhs Clinics

  dba Salinas Valley Health Clinics

  • Multi-Specialty Clinic/Center
  • Salinas, CA
  • NPI 1093158347
  Medicare reassignment NPD
• University of Wisconsin Medical Foundation, Inc

  • Multi-Specialty Clinic/Center
  • Middleton, WI
  • NPI 1598784555
  Medicare reassignment NPD
• Salinas Valley Memorial Healthcare System

  • Community/Retail Pharmacy
  • Salinas, CA
  • NPI 1659019578
  NPD
• Svmhs Clinics

  • Physical Therapist
  • Salinas, CA
  • NPI 1518486893
  NPD
• University of Wisconsin Medical Foundation, Inc

  • Health Educator
  • Madison, WI
  • NPI 1487414082
  NPD
• Lancelot O Alexander MD a Medical Corporation

  • Specialist
  • Salinas, CA
  • NPI 1134279532
  NPD (past)

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1811906316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WILSON RD STE 100",
            "city": "MONTEREY",
            "state": "CA",
            "postal_code": "939407885",
            "telephone_number": "831-242-8301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 5TH ST",
            "city": "GONZALES",
            "state": "CA",
            "postal_code": "939269491",
            "telephone_number": "831-675-3601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5249 E Terrace Dr",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537188339",
            "country_code": "US",
            "telephone_number": "608-265-1212",
            "fax_number": "082-650-9356",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "355 Abbott St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Salinas",
            "state": "CA",
            "postal_code": "939014484",
            "country_code": "US",
            "telephone_number": "831-751-7070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AMANDA",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A91439",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "77092-20",
            "primary": false
        },
        {
            "code": "2080C0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Child Abuse Pediatrics",
            "state": "WI",
            "license": "77092-20",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ajackson1265751@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "5249 E Terrace Dr",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537188339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robyn Adela Guzik, ASW
• Lizbeth Guzman-Palacios
• Maria Rashel Guzman
• Ha Jung Kim, Dds45-321953 (Gonzales Dental Care)
• Janeth E Herrejon
• Holly James
• Ha Jung Kim
• Daniel Woo Kook, DDS
• Jaeho Joshua Lee, PA-C
• Claire Michelle Lewis, PHARMD

• Pediatrics Physician in Gonzales, CA
• Providers in Gonzales, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; 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.