Laura Rae Jackam, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.008854RX Issued in OH

Practice address

4975 Foote Rd.
Ste. #400
Medina, OH 44256-9048

Phone

(330) 591-9038

Fax

(330) 722-8585

NPI assigned

Jan 4, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Apex Dermatology and Skin Surgery Center, LLCGroup PAC ID 1052589777, 52 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ljackam235156@ehrdirect.uhhospitals.org

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.

• Apex Dermatology and Skin Surgery Center, LLC

  • Dermatology Physician
  • Mayfield Heights, OH
  • NPI 1689973638
  Medicare reassignment Care Compare group
• Gary R Kutsikovich MD and Associates Inc

  • Neurology Physician
  • Mentor, OH
  • NPI 1841250420
  NPD (past)
• SCH Professional Corporation

  • Family Medicine Physician
  • Salem, OH
  • NPI 1619959822
  NPD (past)

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

{
    "created_epoch": "1672790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1922711993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 AUBURN DR.",
            "address_2": "STE. 350",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224327",
            "telephone_number": "440-646-1600",
            "fax_number": "440-646-1505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4975 FOOTE RD.",
            "address_2": "STE. #400",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442569048",
            "telephone_number": "330-591-9038",
            "fax_number": "330-722-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKAM",
        "first_name": "LAURA",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-04",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.008854RX",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0081746",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Inpsychful Minds LLC
• Integrative Counseling Services
• Integrity Counseling LLC
• Intervention for Peace Inc.
• Helen F Jablonowski, RN
• Glenna S Jackson, M.D.
• Krista Jackson, LPN
• Qiana Caprice Jackson
• Raytionna Danielle Jackson
• Sarah Murtha Jackson

• Physician Assistant in Medina, OH
• Providers in Medina, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; 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.