Christine Jackson, MD
Individual provider Active NPI Cardiovascular Disease Physician · Eagar, AZ
NPI 1861476889 · NPPES record last updated Jan 4, 2010
Key facts
- NPI
- 1861476889
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 13940 (AZ)
- Practice address
- 162 W Central Ave
Eagar, AZ 85925-9707 - Phone
- (928) 333-1030
- Fax
- (928) 333-1033
- NPI assigned
- Dec 2, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- University of Arizona College of Medicine, 1978
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- White Mountain Regional Medical Center
Practice addresses (Care Compare)
118 S Mountain Ave
Springerville, AZ 85938-5104
Phone (928) 333-4368
Hospital & facility affiliations
- White Mountain Regional Medical Center
- Summit Healthcare Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050525001294 | AZ | Practitioner - Cardiovascular Disease (Cardiology) | 0840232278 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| White Mountain Regional Medical Center | Current |
Accepting new patients | |
| Heart Center of Northeastern Arizona, LLC | Cardiovascular Disease | Past | Accepting new patients |
| Northern Arizona Heart Center | Past | Accepting new patients |
Locations
118 S Mountain Ave
Springerville, AZ 85938
Phone (928) 333-4368
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 13940 | AZ | Yes |
Addresses
Primary practice location
162 W Central Ave
Eagar, AZ 85925-9707
Mailing address
PO Box 1120
Eagar, AZ 85925-1120
Phone (928) 333-1030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 274613 | Medicaid | AZ |
Other providers in Eagar, AZ
- Reece Kirby Hadlock
- Scott R Hamblin
- Kayle L Haws
- James Heap
- Steven Paul Heap
- Jim W Crosby DDS PC
- La Casa Serena
- Nicholas Talbert Mallory
- Candice Marissa Matthews
- Brooke Arlene McCarthy
All providers in Eagar, AZ · Cardiovascular Disease Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.