NPIMap

Individual provider Active NPI

Brianna Shanice Jackson, PA-C

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1922679489
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5587-23 Issued in WI
Practice address
2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709
Phone
(414) 372-8080
Fax
(414) 562-8084
NPI assigned
Jul 6, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5587-23 WI Primary

Addresses

Primary practice location

2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709

Mailing address

2555 N Dr Martin Luther King Jr Dr
Milwaukee, WI 53212-2709
Phone (414) 372-8080

Other practice location 1

8200 W Silver Spring Dr
Milwaukee, WI 53218-2552
Phone (414) 760-3900

Other identifiers 1

IdentifierTypeStateIssuer
100180686MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20210923002622 WI Practitioner - Physician Assistant 3072910637 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5587-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Milwaukee Health Services Inc CurrentSince Sep 13, 2021 Accepting new patients
Progressive Community Health Centers, Inc. CurrentSince Aug 1, 2024 Accepting new patients

Locations

945 N 12th St
Ste 102
Milwaukee, WI 53233

2555 N Mlk Dr
Milwaukee, WI 53212
Phone (414) 267-2022

1452 N 7th St
Fl 2
Milwaukee, WI 53205
Phone (414) 935-8000

945 N 12th St
Milwaukee, WI 53233
Phone (414) 219-5800

8200 W Silver Spring Dr
Milwaukee, WI 53218
Phone (414) 760-3900

3522 W Lisbon Ave
Milwaukee, WI 53208
Phone (414) 935-8000

Interoperability endpoints

  • Direct secure messaging: bjackson736413@direct.ochin.org

Organizations & group practices 9

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 4

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

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advantage Physical Therapy and Sports Rehab, LLC 289 clinicians
Progressive Community Health Centers Inc 24 clinicians

Practice addresses (Care Compare)

2578 N Martin Luther King Dr
Milwaukee, WI 53212-2710
Phone (419) 221-6717

3522 W Lisbon Ave
Milwaukee, WI 53208-1953
Phone 41493580001437

3840 N Oakland Ave
Shorewood, WI 53211-2239
Phone (419) 221-6717

Hospital & facility affiliations

  • Ascension SE Wisconsin Hospital Hospital, Milwaukee, WI, CCN 520136
  • Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138

NPI Registry JSON

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

{
    "created_epoch": "1625529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1922679489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 N DR MARTIN LUTHER KING JR DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122709",
            "telephone_number": "414-372-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 N MARTIN LUTHER KING DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122709",
            "telephone_number": "414-372-8080",
            "fax_number": "414-562-8084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8200 W Silver Spring Dr",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532182552",
            "country_code": "US",
            "telephone_number": "414-760-3900",
            "fax_number": "414-464-6076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRIANNA",
        "middle_name": "SHANICE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-06",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "5587-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100180686",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.