Stephanie L Jackson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

51415 Issued in AZ

Practice address

10900 N Scottsdale Rd
Suite 603
Scottsdale, AZ 85254-5216

Phone

(480) 882-7470

Fax

(480) 922-2472

NPI assigned

Jan 25, 2006

Last updated

Jul 25, 2016By 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 2

Addresses

Other identifiers 2

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

Internal Medicine

Education

Washington University School of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner Primary Care Physicians Arizona LLCGroup PAC ID 6406020155, 236 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1659640902
  Medicare reassignment Care Compare group NPD
• Honorhealth Ambulatory

  dba HonorHealth Research Institute

  • Hematology & Oncology Physician
  • Scottsdale, AZ
  • NPI 1407050917
  Medicare reassignment NPD
• Honorhealth Medical Group, LLC

  • Primary Care Clinic/Center
  • Peoria, AZ
  • NPI 1043851793
  Medicare reassignment NPD
• Banner Primary Care Physicians Arizona LLC

  • Clinical Medical Laboratory
  • Peoria, AZ
  • NPI 1649544362
  NPD
• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1790306066
  NPD
• Honorhealth Ambulatory

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1891518130
  NPD
• Honorhealth Medical Group, LLC

  • Family Medicine Physician
  • Tempe, AZ
  • NPI 1205450533
  NPD
• Honorhealth Medical Group, LLC

  • Family Medicine Physician
  • Scottsdale, AZ
  • NPI 1285338343
  NPD
• Scottsdale Healthcare Corporation

  • Family Medicine Physician
  • Scottsdale, AZ
  • NPI 1497163166
  NPD
• Banner Concierge Services Arcadia LLC

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1164110201
  NPD (past)
• Peacehealth

  dba PeaceHealth Medical Group

  • Internal Medicine Physician
  • Bellingham, WA
  • NPI 1356309553
  NPD (past)

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469404800000",
    "number": "1861462509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W UTOPIA RD",
            "address_2": "SUITE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850274171",
            "telephone_number": "623-434-6200",
            "fax_number": "623-434-6164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10900 N SCOTTSDALE RD",
            "address_2": "SUITE 603",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852545216",
            "telephone_number": "480-882-7470",
            "fax_number": "480-922-2472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEPHANIE",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2016-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD23663",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "51415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286902",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120461",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kirk Gordon Jackson, RPH
• Kyle Jackson, PH.D. PSYCHOLOGY
• Leigh Ann M. Jackson
• Melinda Ann Jackson, FNP-C
• Roger Jackson
• Jeffrey D Jaco, P.A.-C.
• Sneha Jacob, M.D
• Barbara Jacoboski, CSCD CCC SLP
• Irene Leivas Jacobs, MC, LPC, CSAT
• Valerie L Jacobs, MD, PHD

• Internal Medicine Physician in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; 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.