JON R JACKSON (NPI# 1285886051) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285886051 |
| Entity Type | Individual |
| Full Name | JON R JACKSON |
| Practice Address |
337 Fowler St Roseburg OR 97470 |
| Mailing Address |
272 Medical Loop Suite E Roseburg OR 97471 |
| Practice Telephone | 5414403532 |
| Practice Fax Number | 5414403554 |
| Mailing Telephone | 5414403532 |
| Mailing Fax Number | 5414403554 |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2015-08-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972815934 | Jon Grant Jackson | Pharmacist | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2010-07-07 |
| 1760669345 | Jon C Jackson | Psychiatry & Neurology | 2500 North State Street, Jackson, MS 39216 | 2008-01-26 |
| 1598840472 | Jon Gustaf Jackson | Psychiatry & Neurology | 1335 North Dutton Ave, Santa Rosa, CA 95401 | 2006-10-26 |
| 1093724551 | Jon C Jackson | Specialist | 4770 S Ridgewood Ave, Port Orange, FL 32127-4544 | 2006-08-05 |
| 1740254978 | Jon Ryan Jackson | Plastic Surgery | 1890 Sw Health Pkwy, Suite 301, Naples, FL 34109-0473 | 2006-02-14 |
| 1013909118 | Jon Richard Jackson | Internal Medicine | 5000 Hennessy Blvd, Baton Rouge, LA 70808-4375 | 2005-08-16 |
| Street Address |
337 FOWLER ST |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97470 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366810996 | Jessica Paselk | Case Manager/Care Coordinator | 337 Fowler St, Roseburg, OR 97470 | 2015-09-14 |
| 1336559772 | Jami L Baimbridge | Case Manager/Care Coordinator | 337 Fowler St, Roseburg, OR 97470 | 2014-05-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326547134 | Thoughtwork, LLC | Social Worker | 178 Nw Garden Valley Blvd, Roseburg, OR 97470 | 2018-02-07 |
| 1063932960 | Go Mo, LLC | Durable Medical Equipment & Medical Supplies | 627 Se Jackson St, Roseburg, OR 97470 | 2017-06-21 |
| 1497123335 | Brandi N Hamilton | Counselor | 215 S.e. Jackson, Roseburg, OR 97470 | 2015-09-09 |
| 1285031203 | Aric Fromdahl | Counselor | 215 Se Jackson, Roseburg, OR 97470 | 2014-11-20 |
| 1801292438 | Robin Knebel | Counselor | 215 Se Jackson St., Roseburg, OR 97470 | 2014-11-10 |
| 1700282415 | Samantha Marie Shelley | Counselor | 215 Se Jackson Street, Roseburg, OR 97470 | 2014-11-06 |
| 1043610660 | Cynthia Simmons | Counselor | 150 Ne Kenneth Ford Drive, Roseburg, OR 97470 | 2014-09-02 |
| 1083025431 | Toni Damewood Msn Pmhnp-bc | Nurse Practitioner | 770 Se Kane Street, Roseburg, OR 97470 | 2014-05-19 |
| 1801226196 | Denise Ingeman | Registered Nurse | 1548 South East Pine Street, Roseburg, OR 97470 | 2013-11-22 |
| 1356606909 | Carla Junette Rambel | Massage Therapist | 566 S.e. Jackson, Roseburg, OR 97470 | 2012-07-10 |
| Find all providers in zip 97470 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770034589 | Evie Jepsen | Case Manager/Care Coordinator | 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 | 2016-10-17 |
| 1932580586 | Jeffrey Mark Wareham | Case Manager/Care Coordinator | 2700 Medical Loop, Annex B, Roseburg, OR 97471 | 2015-06-09 |
| 1215040175 | Patricia Ann Taylor | Case Manager/Care Coordinator | 337 Se Fowler St, Roseburg, OR 97470-4348 | 2006-08-16 |
| 1194322396 | Christopher Hudgeon | Case Manager/Care Coordinator | 548 Se Jackson St, Roseburg, OR 97470-4983 | 2020-10-01 |
| 1538775754 | Aurora Petterson | Case Manager/Care Coordinator | 621 W Madrone St, Roseburg, OR 97470-3090 | 2020-09-22 |
| 1265040018 | Angelica Laurent | Case Manager/Care Coordinator | 621 W Madrone St, Roseburg, OR 97470-3090 | 2020-07-17 |
| 1770101719 | Travis Mcdowell | Case Manager/Care Coordinator | 283 Se Fowler St Ste 2, Roseburg, OR 97470-3309 | 2020-07-07 |
| 1417574898 | Bryn Orr | Case Manager/Care Coordinator | 621 W Madrone St, Roseburg, OR 97470-3090 | 2020-07-01 |
| 1689298754 | Cindy Walls | Case Manager/Care Coordinator | 621 W Madrone St, Roseburg, OR 97470-3090 | 2020-06-03 |
| 1144849589 | Larry Dale Clark | Case Manager/Care Coordinator | 621 W Madrone St, Roseburg, OR 97470-3090 | 2020-04-15 |
| Find all providers in ROSEBURG | ||||
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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.