Brock Jackson, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

32949 Issued in AZ

Practice address

1661 E Camelback Rd
Suite 160
Phoenix, AZ 85016-3911

Phone

(602) 241-1671

Fax

(602) 274-6181

NPI assigned

Jun 17, 2005

Sex

Male

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 AZ

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 1

Specialty

Obstetrics/Gynecology

Education

Georgetown University School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arizona OB GYN Affiliates PCGroup PAC ID 7911094040, 122 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner - University Medical Center Phoenix Hospital, Phoenix, AZ, CCN 030002

Merit-based Incentive Payment System (MIPS)

Final score

82.85 of 100Reported as group

Quality

69.75

Promoting interoperability

98

Improvement activities

40

Cost

68.18

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brock.jackson.1@14294.direct.athenahealth.com

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.

• Arizona OB GYN Affiliates PC

  • Specialist
  • Phoenix, AZ
  • NPI 1750589404
  Medicare reassignment Care Compare group NPD
• Banner - University Physician Specialists LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1437529245
  Medicare reassignment NPD
• Banner - University Physician Specialists LLC

  • Durable Medical Equipment & Medical Supplies
  • Phoenix, AZ
  • NPI 1164255865
  NPD
• Banner - University Medical Center Phoenix

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1841224870
  NPD (past)

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

• Banner - University Medical Center Phoenix

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1841224870
  Care Compare affiliation

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426723200000",
    "number": "1821093667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 E CAMELBACK RD",
            "address_2": "SUITE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850163911",
            "telephone_number": "602-241-1671",
            "fax_number": "602-274-6181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 E CAMELBACK RD",
            "address_2": "SUITE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850163911",
            "telephone_number": "602-241-1671",
            "fax_number": "602-274-6181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BROCK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2015-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "32949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "939902",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Jackson-Hamus
• Tana Jackson-Wilson
• Anthony Rashad Jackson, PA
• Azel Jackson, LPC
• Beverly Yvonne Jackson, RN, MSN
• Byron Jackson
• Cate Jackson, DNP, PMHNP-BC
• Cherie Jackson
• Dakahri Jackson
• Darlene Jackson

• Specialist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.