TIMOTHY JACKS (NPI# 1164686549) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164686549 |
| Entity Type | Individual |
| Full Name | TIMOTHY JACKS |
| Credential | D.O. |
| Practice Address |
4540 E Baseline Rd Suite 108 Mesa AZ 85206-4613 |
| Practice Telephone | 4808923880 |
| Practice Fax Number | 4805454551 |
| Mailing Telephone | 4808923880 |
| Mailing Fax Number | 4805454551 |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2013-05-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | R70095 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | TRAINING PERMIT | R70095 | 01 |
| Street Address |
4540 E BASELINE RD SUITE 108 |
| City | MESA |
| State | AZ |
| Zip Code | 85206-4613 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225031503 | Jo Merriwether Knatz | Obstetrics & Gynecology | 4540 E Baseline Rd, Ste 115, Mesa, AZ 85206-4617 | 2005-05-31 |
| 1770034787 | Amanda Hines Kwilosz | Physician Assistant | 4540 E Baseline Rd, #113, Mesa, AZ 85206-4613 | 2016-10-14 |
| 1225489511 | Wize Healthcare LLC | Pain Medicine | 4540 E Baseline Rd, 105, Mesa, AZ 85206-4613 | 2016-06-28 |
| 1366854721 | Cbd Healthcare LLC | Chiropractor | 4540 E Baseline Rd, #105, Mesa, AZ 85206-4613 | 2014-05-20 |
| 1619399714 | Cd Healthcare,llc | Physical Medicine & Rehabilitation | 4540 E Baseline Rd, Suite 105, Mesa, AZ 85206-4613 | 2014-01-09 |
| 1740601962 | Calgary Medical LLC | Physical Medicine & Rehabilitation | 4540 E Baseline Rd, Suite 105, Mesa, AZ 85206-4613 | 2013-12-16 |
| 1316388648 | Annette Villalobos Lopez | Nurse Practitioner | 4540 E Baseline Rd, Mesa, AZ 85206-4613 | 2013-07-15 |
| 1912202904 | Craig Brian Defries | Chiropractor | 4540 E Baseline Rd, Suite 105, Mesa, AZ 85206-4613 | 2011-01-21 |
| 1063655223 | The Wellness Way, Inc. | Chiropractor | 4540 E Baseline Rd, Suite 112, Mesa, AZ 85206-4613 | 2009-04-16 |
| 1467692897 | Brian Wortzel | Physician Assistant | 4540 E Baseline Rd, 115, Mesa, AZ 85206-4613 | 2009-02-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720693062 | Inner Balance Counseling LLC | Counselor | 4111 E Auto Valley Drive, Suite 101, Mesa, AZ 85206 | 2020-09-14 |
| 1356978969 | Choices 4 Change Counseling and Coaching LLC | Social Worker | 3707 E Southern Ave., Suite 2027, Mesa, AZ 85206 | 2020-03-24 |
| 1023651288 | Jason Mcclure | Hearing Instrument Specialist | 5540 E Broadway Rd., Mesa, AZ 85206 | 2019-10-21 |
| 1255995361 | Vhs of Phoenix Inc | General Acute Care Hospital | 5750 E. Baseline Rd., Mesa, AZ 85206 | 2019-04-24 |
| 1932682184 | Adam Fishel Frose | Psychologist | 4555 E Inverness Ave Ste 112, Mesa, AZ 85206 | 2018-09-13 |
| 1376024737 | Robyn Kathleen Hall | Psychologist | 4115 East Valley Auto Drive, Suite 208, Mesa, AZ 85206 | 2018-08-23 |
| 1790264984 | Perspective Health, LLC | Clinic/Center | 1959 S. Power Rd, Suite 103, #206, Mesa, AZ 85206 | 2018-08-09 |
| 1033605159 | Rebecca Ann Maro | Nurse Practitioner | 6750 E Baywood Ave Ste 502, Mesa, AZ 85206 | 2018-07-02 |
| 1982195624 | Spark Performance and Physiotherapy | Clinic/Center | 6056 East Basline Road, Suite 147, Mesa, AZ 85206 | 2018-05-29 |
| 1336645993 | Ashley Wright | Audiologist-Hearing Aid Fitter | 1423 S Higley Rd Ste 119, Mesa, AZ 85206 | 2018-04-03 |
| Find all providers in zip 85206 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295250009 | Pleasant Pediatrics Plc | Pediatrics | 421 W Brown Rd, Mesa, AZ 85201-3336 | 2017-08-14 |
| 1407285307 | Noel John M. Carrasco | Pediatrics | 6540 E Redmont Dr, #14, Mesa, AZ 85215-1088 | 2013-11-01 |
| 1609171115 | Marc Andrew Ellsworth | Pediatrics | 4107 E Grove Cir, Mesa, AZ 85206-3313 | 2011-01-13 |
| 1033422571 | Eric Gabriel Gonzalez | Pediatrics | 616 E Southern Ave, #103, Mesa, AZ 85204 | 2010-07-26 |
| 1033388780 | Jyoti S. Lebonheur | Pediatrics | 1840 S. Stapley Drive, Suite 101, Mesa, AZ 85204 | 2008-02-27 |
| 1265619373 | Anthony Ikechukwu Ani | Pediatrics | 1400 S Dobson Rd Fl 5, Mesa, AZ 85202-4707 | 2008-01-31 |
| 1235316175 | Bernadette R Rosenberg | Pediatrics | 815 E University Dr, Mesa, AZ 85203-8032 | 2008-01-23 |
| 1477748259 | Ayah Yousif Elmaghrabi | Pediatrics | 1367 S Country Club Dr Unit 1072, Mesa, AZ 85210-5289 | 2007-09-13 |
| 1578763751 | Melanie Alarcio | Pediatrics | 2812 N Norwalk Ste 10-119, Mesa, AZ 85215-1148 | 2007-07-25 |
| 1164621470 | Ruben Omar Espinoza | Pediatrics | 1950 S. Country Club Suite 101, Mesa, AZ 85210-6871 | 2007-07-16 |
| Find all providers in MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.