Stacy Marie Jackson, DDS in Boulder, CO - Medicare Dentist Provider

Stacy Marie Jackson, DDS is a medicare enrolled "Dentist - Pediatric Dentistry" provider in Boulder, Colorado. Her current practice location is 3400 Penrose Pl Ste 107, Boulder, Colorado. You can reach out to her office (for appointments etc.) via phone at (303) 443-8250.

Stacy Marie Jackson is licensed to practice in Colorado (license number DEN.00202791) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1043530991.

Contact Information

	Stacy Marie Jackson, DDS
	3400 Penrose Pl Ste 107, Boulder, CO 80301-1809
	(303) 443-8250
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Stacy Marie Jackson
Gender	Female
Speciality	Dentist - Pediatric Dentistry
Location	3400 Penrose Pl Ste 107, Boulder, Colorado
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1043530991
Provider Enumeration Date: 06/02/2010
Last Update Date: 04/26/2023

Medicare PECOS Information:

PECOS PAC ID: 7214363662
Enrollment ID: I20220725000465

Medical Identifiers

Medical identifiers for Stacy Marie Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1043530991	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
122300000X	Dentist	2010016174 (Missouri)	Secondary
1223P0221X	Dentist - Pediatric Dentistry	DEN.00202791 (Colorado)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Stacy Marie Jackson allows following entities to bill medicare on her behalf.

Entity Name	Denver Health And Hospital Authority
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1477569838 PECOS PAC ID: 4688583578 Enrollment ID: O20031105000211

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Stacy Marie Jackson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Stacy Marie Jackson, DDS 291 Maddox Lane, Erie, CO 80516 Ph: (785) 249-2973	Stacy Marie Jackson, DDS 3400 Penrose Pl Ste 107, Boulder, CO 80301-1809 Ph: (303) 443-8250

Reviews and Comments

Dentist in Boulder, CO

Dr. Luke Vernon, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 2100 28th St Unit 4f, Boulder, CO 80301 Phone: 574-721-2039
Dr. Milena Halek, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 2430 Broadway St, Ste 101, Boulder, CO 80304 Phone: 303-786-8899 Fax: 303-247-1881
Andrea M Mustian, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 2006 Broadway St, #201, Boulder, CO 80302 Phone: 303-443-4984
Dr. George Bruce Douglas, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 3100 Arapahoe Ave, Suite #300, Boulder, CO 80303 Phone: 303-449-6621 Fax: 303-413-9341
Dr. David Lewis Evans Jr., D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 1455 Yarmouth Ave, Suite 116, Boulder, CO 80304 Phone: 303-442-0990 Fax: 303-546-9735
Dr. Lonnie M Sibley Jr., DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 4155 Darley Ave, Boulder, CO 80305 Phone: 303-499-7072 Fax: 303-200-7375
Dr. Brett Edward Amedro, D.D.S. Dentist Medicare: Medicare Enrolled Practice Location: 3400 Penrose Pl Ste 105, Boulder, CO 80301 Phone: 303-449-3131 Fax: 303-449-9487

Stacy Marie Jackson, DDS - Medicare Dentist in Boulder, CO