BRUCE JACKSON (NPI# 1467711986) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467711986 |
| Entity Type | Individual |
| Full Name | BRUCE JACKSON |
| Practice Address |
5715 S Broadway Los Angeles CA 90037-4131 |
| Practice Telephone | 3239480444 |
| Practice Fax Number | 3239480443 |
| Mailing Telephone | 3239480444 |
| Mailing Fax Number | 3239480443 |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2012-05-04 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992039291 | Bruce C. Jackson | Chiropractor | 201 Brighton Park Blvd., Ste. 4, Frankfort, KY 40601-8447 | 2009-09-21 |
| 1851430532 | Bruce W Jackson | Dentist | 111 Lilac Dr, Liberal, KS 67901 | 2007-02-06 |
| 1124072087 | Bruce L Jackson | Physician Assistant | 15863 Kasota Rd, Apple Valley, CA 92307-4507 | 2006-05-22 |
| 1598133571 | Bruce Jackson | Registered Nurse | 2828 1st Ave Ste 400, Huntington, WV 25702-1236 | 2015-09-09 |
| 1598819567 | Bruce E Jackson | Counselor | 5455 Almira Dr Se, Bremerton, WA 98311-8330 | 2007-01-23 |
| 1609883438 | Bruce K Jackson | Internal Medicine | 520 N Prospect Ave, Ste. 300, Redondo Beach, CA 90277-3041 | 2006-08-02 |
| 1720039878 | Bruce Arden Jackson II | Dentist | 4829 E Beltline Ave Ne, Grand Rapids, MI 49525-9747 | 2006-05-13 |
| Street Address |
5715 S BROADWAY |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90037-4131 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306947262 | Julie Ann Gray | Social Worker | 5715 S Broadway, Los Angeles, Los Angeles, CA 90037-4131 | 2006-09-25 |
| 1891327441 | Jose E Hernandez | Counselor | 5715 S Broadway, Los Angeles, CA 90037-4131 | 2020-02-11 |
| 1386286490 | Victor Yaquian | Student in an Organized Health Care Education/Training Program | 5715 S Broadway, Los Angeles, CA 90037-4131 | 2019-10-09 |
| 1356983555 | Maria Marroquin | Student in an Organized Health Care Education/Training Program | 5715 S Broadway, Los Angeles, CA 90037-4131 | 2019-10-09 |
| 1295376549 | Kelsey Boyle | Social Worker | 5715 S Broadway, Los Angeles, CA 90037-4131 | 2019-10-07 |
| 1366099822 | Adriana Villa Camacho | Social Worker | 5715 S Broadway, Los Angeles, CA 90037-4131 | 2019-08-20 |
| 1962054122 | Carmenia Matthews | Peer Specialist | 5715 S Broadway, Los Angeles, CA 90037-4131 | 2019-07-09 |
| 1689133035 | Izri Preciado | Student in an Organized Health Care Education/Training Program | 5715 S Broadway, Los Angeles, CA 90037-4131 | 2019-03-15 |
| 1346708021 | Elizabeth Ramirez | Student in an Organized Health Care Education/Training Program | 5715 S Broadway, Los Angeles, CA 90037-4131 | 2019-03-12 |
| 1326502931 | Adrian Tafoya | Social Worker | 5715 S Broadway, Los Angeles, CA 90037-4131 | 2019-01-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871119701 | Carina Lizette Guerra | Nurse Practitioner | St. John's Well Child and Family Center, Inc., 808 W. 58th Street, Los Angeles, CA 90037 | 2020-06-16 |
| 1114556263 | Arm 4 Arm Foundation | Clinic/Center | 231 W Vernon Ave., Suite 101, 201, Los Angeles, CA 90037 | 2020-04-01 |
| 1407329766 | Lucidite Sleep Laboratory & Treatment Center Inc | Clinic/Center | 231 W Vernon Ave. Suite 108, Los Angeles, CA 90037 | 2019-01-09 |
| 1013491505 | Nancy Sandoval | Social Worker | 644 W 42nd Place, Los Angeles, CA 90037 | 2018-09-20 |
| 1932603081 | Adam Wiswell | Psychologist | 3982 S. Figueroa Street, Suite 203, Los Angeles, CA 90037 | 2018-03-22 |
| 1548764392 | St. John's Well Child and Family Center, Inc. | Clinic/Center | 1000 W. 50th St, Los Angeles, CA 90037 | 2018-03-19 |
| 1134637150 | Tamayo Inc & Lascoe Inc Dental Partnership | Dentist | 4400 S Broadway Ste #103, Los Angeles, CA 90037 | 2018-01-11 |
| 1295282283 | Catherine Azzopardi | Social Worker | 4601 S Broadway, Los Angeles, CA 90037 | 2016-09-07 |
| 1619423266 | Esmeralda Garcia | Dietitian, Registered | 808 W. 58th Street, 2nd Floor, Los Angeles, CA 90037 | 2016-09-01 |
| 1225405921 | Sophan Cheng | Nurse Practitioner | 808 W. 58th Street, Los Angeles, CA 90037 | 2015-08-28 |
| Find all providers in zip 90037 | ||||
| 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 |
|---|---|---|---|---|
| 1285242594 | Rocio Jimenez | Case Manager/Care Coordinator | 4650 Sunset Blvd, Mailstop #53, Los Angeles, CA 90027 | 2020-07-22 |
| 1245855725 | Ashley Ivette Berumen | Case Manager/Care Coordinator | 1900 W Slauson Ave, Los Angeles, CA 90047-1129 | 2020-06-10 |
| 1356965776 | Jennifer Yanovski | Case Manager/Care Coordinator | 316 W 2nd St Ste 202, Los Angeles, CA 90012-3527 | 2020-06-01 |
| 1841820560 | Kiara Imani Thomas | Case Manager/Care Coordinator | 226 E 103rd St, Los Angeles, CA 90003-4720 | 2020-01-22 |
| 1023648748 | Christopher Rivas | Case Manager/Care Coordinator | 1410 N Kenmore Ave Apt 5, Los Angeles, CA 90027-5826 | 2020-01-22 |
| 1396383782 | Candace Laolagi | Case Manager/Care Coordinator | 246 E 47th St, Los Angeles, CA 90011-3908 | 2019-12-16 |
| 1902448343 | Aster Libasu | Case Manager/Care Coordinator | 2619 Wilshire Blvd Apt 1005, Los Angeles, CA 90057-3461 | 2019-10-16 |
| 1831749456 | Jasmine Lynn Martinez | Case Manager/Care Coordinator | 6768 Lexington Ave, Los Angeles, CA 90038-1234 | 2019-09-16 |
| 1033762547 | John Charles Gutierrez | Case Manager/Care Coordinator | 4265 S Normandie Ave, Los Angeles, CA 90037-2324 | 2019-07-23 |
| 1609429976 | Vianey Colon | Case Manager/Care Coordinator | 11601 S Western Ave # O, Los Angeles, CA 90047-5006 | 2019-07-16 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90037 |
Please comment or provide details below to improve the information on BRUCE JACKSON.
| 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.