Dr Tyler Pembroke Jackson, MD in Santa Monica, CA

Dr Tyler Pembroke Jackson, MD is a medicare enrolled "Emergency Medicine" physician in Santa Monica, California. He went to University Of Utah School Of Medicine and graduated in 2020 and has 6 years of diverse experience with area of expertise as Sports Medicine. He is a member of the group practice Regents Of The University Of California and his current practice location is 1250 16th St Ste 2100, Santa Monica, California. You can reach out to his office (for appointments etc.) via phone at (424) 259-6593.

Dr Tyler Pembroke Jackson is licensed to practice in California (license number A196288) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1295355816.

Contact Information

	Dr Tyler Pembroke Jackson, MD
	1250 16th St Ste 2100, Santa Monica, CA 90404-1249
	(424) 259-6593
	Not Available

Map and Direction

Physician's Profile

Full Name	Dr Tyler Pembroke Jackson
Gender	Male
Speciality	Sports Medicine
Experience	6 Years
Location	1250 16th St Ste 2100, Santa Monica, California
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Dr Tyler Pembroke Jackson attended and graduated from University Of Utah School Of Medicine in 2020

NPI Data:

NPI Number: 1295355816
Provider Enumeration Date: 04/23/2020
Last Update Date: 02/02/2026

Medicare PECOS Information:

PECOS PAC ID: 7810319803
Enrollment ID: I20240820003839

Medical Identifiers

Medical identifiers for Dr Tyler Pembroke Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1295355816	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207P00000X	Emergency Medicine	A196288 (California)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Santa Monica - Ucla Med Ctr & Orthopaedic Hospital	Santa monica, CA	Hospital
Ronald Reagan Ucla Medical Center	Los angeles, CA	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Regents Of The University Of California	2062312291	61

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. Dr Tyler Pembroke Jackson allows following entities to bill medicare on his behalf.

Entity Name	Regents Of The Univ Of Ca Emer Med
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1104889138 PECOS PAC ID: 4284538521 Enrollment ID: O20031119001020

Entity Name	Regents Of The University Of California
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1528179793 PECOS PAC ID: 2062312291 Enrollment ID: O20040112000584

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. Dr Tyler Pembroke 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
Dr Tyler Pembroke Jackson, MD 5767 W Century Blvd Ste 400, Los Angeles, CA 90045-5631 Ph: () -	Dr Tyler Pembroke Jackson, MD 1250 16th St Ste 2100, Santa Monica, CA 90404-1249 Ph: (424) 259-6593

Reviews and Comments

Emergency Medicine Doctors in Santa Monica, CA

William Shyy, M.D. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1250 16th St, Santa Monica, CA 90404 Phone: 310-794-7700
Edward S Cotner, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1328 Twenty Second Street, Santa Monica, CA 90404 Phone: 310-582-7089
Walid H. Ghurabi, D.O. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1250 16th St, Emergency Department, Santa Monica, CA 90404 Phone: 310-319-4000
Dr. Michael Jeffrey Weitz, MD. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1328 Twenty Second St, Santa Monica, CA 90404 Phone: 310-582-7089
Dr. Robert Lee Hook Iii, M.D. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1250 16th St, Santa Monica, CA 90404 Phone: 310-794-7700
Ms. Rosemarie Bustos Diaz, Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1250 16th St, Santa Monica, CA 90404 Phone: 310-794-7700
Amy L Kijner, PA Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 1328 22nd St, Santa Monica, CA 90404 Phone: 310-582-7089

Dr Tyler Pembroke Jackson, MD - Medicare Sports Medicine in Santa Monica, CA