NPIMap

Individual provider Active NPI

Matthew Wayne Jackson, M.D.

  • Radiation Oncology Physician
  • Fort Collins, CO
National Provider Identifier
1821359795
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
DR.0070527 Issued in CO
Practice address
2121 E Harmony Rd Unit 160
Fort Collins, CO 80528-3413
Phone
(970) 482-3328
Fax
(970) 482-1433
NPI assigned
Jun 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X TL.0004644 CO
Student in an Organized Health Care Education/Training Program 390200000X
Radiation Oncology Physician 2085R0001X DR.0070527 CO Primary

Addresses

Primary practice location

2121 E Harmony Rd Unit 160
Fort Collins, CO 80528-3413

Mailing address

2121 E Harmony Rd Unit 160
Fort Collins, CO 80528-3413
Phone (970) 482-3328

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20230810002381 CO Practitioner - Radiation Oncology 5395987390 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of Texas Medical School at San Antonio, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

2121 E Harmony Rd
Unit 160 Uchmg Radiation Oncology
Fort Collins, CO 80528-3413
Phone (970) 482-3328

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0070527COMDRadiation Oncology Physician
TL.0004644COMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Pulmonary Disease CurrentSince Jul 10, 2023 Accepting new patients
Poudre Valley Medical Group, LLC Pulmonary Disease CurrentSince Jul 10, 2023 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

2121 E Harmony Rd
Unit 160
Fort Collins, CO 80528
Phone (970) 482-3328

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 2

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1821359795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD UNIT 160",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283413",
            "telephone_number": "970-482-3328",
            "fax_number": "970-482-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD UNIT 160",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283413",
            "telephone_number": "970-482-3328",
            "fax_number": "970-482-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MATTHEW",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-06",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CO",
            "license": "TL.0004644",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CO",
            "license": "DR.0070527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.