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MR. BRUCE L JACKSON P.A. NPI 1124072087


NPI Information

NPI: 1124072087
Provider Name: MR. BRUCE L JACKSON, P.A.
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
15863 KASOTA RD
APPLE VALLEY, CA
ZIP 92307
Phone: (760) 948-1454
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MR. Bruce L Jackson, P.A. is a medical physician assistant in Apple Valley, CA. MR. Bruce L Jackson, P.A. NPI is 1124072087. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

15863 KASOTA RD
APPLE VALLEY, CA
ZIP 92307-507
Phone: (760) 948-1454
Fax: (760) 948-6100

The NPI 1124072087 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Urinalysis, manual test (HCPCS:81002)
  • Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)

The enumeration date for this NPI number is 5/22/2006 and was last updated on 7/8/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363AM0700XPhysician AssistantMedicalPA14185CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1ZZZ37917ZMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
2GR0050902MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.