Shannon Jackson, PA-C in Mishawaka, IN - Medicare Physician Assistant

Shannon Jackson, PA-C is a medicare enrolled "Physician Assistant" in Mishawaka, Indiana. She graduated from nursing school in 2018 and has 8 years of diverse experience with area of expertise as Physician Assistant. She is a member of the group practice Lakeland Medical Practices, Lakeland Community Hospital Watervliet and her current practice location is 611 E Douglas Rd Ste 203, Mishawaka, Indiana. You can reach out to her office (for appointments etc.) via phone at (574) 335-6640.

Shannon Jackson is licensed to practice in Indiana (license number 10005009A) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1134616584.

Contact Information

	Shannon Jackson, PA-C
	611 E Douglas Rd Ste 203, Mishawaka, IN 46545-1467
	(574) 335-6640
	(574) 335-0621

Map and Direction

Provider's Profile

Full Name	Shannon Jackson
Gender	Female
Speciality	Physician Assistant
Experience	8 Years
Location	611 E Douglas Rd Ste 203, Mishawaka, Indiana
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Shannon Jackson graduated from nursing school in 2018

NPI Data:

NPI Number: 1134616584
Provider Enumeration Date: 04/20/2018
Last Update Date: 10/14/2025

Medicare PECOS Information:

PECOS PAC ID: 9335490127
Enrollment ID: I20221020001245

Medical Identifiers

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

Identifier	Type	State	Issuer
1134616584	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363A00000X	Physician Assistant	10005009A (Indiana)	Primary
363A00000X	Physician Assistant	5601011128 (Michigan)	Secondary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Lakeland Hospital, St Joseph	St joseph, MI	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Lakeland Medical Practices	1658427042	252
Lakeland Community Hospital Watervliet	7416942750	41

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. Shannon 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
Shannon Jackson, PA-C 5215 Holy Cross Pkwy, Mishawaka, IN 46545-1469 Ph: () -	Shannon Jackson, PA-C 611 E Douglas Rd Ste 203, Mishawaka, IN 46545-1467 Ph: (574) 335-6640

Reviews and Comments

Physician Assistant Nurses in Mishawaka, IN

Megan Michelle Poole, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 5215 Holy Cross Pkwy, Mishawaka, IN 46545 Phone: 574-335-5000
Collins Abere, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 5215 Holy Cross Pkwy, Mishawaka, IN 46545 Phone: 574-335-5000
Mrs. Diana E Perez - Solano, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 611 E Douglas Rd Ste 207, Mishawaka, IN 46545 Phone: 574-335-6850 Fax: 574-335-0849
Emily Elston, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 505 W Cleveland Rd, Mishawaka, IN 46545 Phone: 574-235-3135
Gabriela Vettorello, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1802 Day Rd, Mishawaka, IN 46545 Phone: 574-204-7200
Emily Grace Gouker, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 270 E Day Rd Ste 280, Mishawaka, IN 46545 Phone: 574-271-0268 Fax: 574-271-0395

Shannon Jackson, PA-C - Medicare Physician Assistant in Mishawaka, IN