| Shannon Jackson, PA-C | |
|
611 E Douglas Rd Ste 203, Mishawaka, IN 46545-1467 | |
| (574) 335-6640 | |
| (574) 335-0621 |
| 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. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134616584 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 10005009A (Indiana) | Primary |
| 363A00000X | Physician Assistant | 5601011128 (Michigan) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Saint Joseph Regional Medical Center | Mishawaka, IN | Hospital |
| Saint Joseph Regional Medical Center - Plymouth | Plymouth, IN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Saint Joseph Regional Medical Center Inc | 8325950843 | 137 |
| Entity Name | Saint Joseph Regional Medical Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1225082878 PECOS PAC ID: 8325950843 Enrollment ID: O20040708000757 |
| Mailing Address | Practice Location Address |
|---|---|
| Shannon Jackson, PA-C 5215 Holy Cross Pkwy, Mishawaka, IN 46545-1469 Ph: Not Available | Shannon Jackson, PA-C 611 E Douglas Rd Ste 203, Mishawaka, IN 46545-1467 Ph: (574) 335-6640 |
Azucena Hernandez, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1802 Day Rd, Mishawaka, IN 46545 Phone: 574-204-7200 |
Megan Michelle Poole, PA-C Physician Assistant Medicare: May Accept Medicare Assignments Practice Location: 5215 Holy Cross Pkwy, Mishawaka, IN 46545 Phone: 574-335-5000 |
Silas Greathouse, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 5125 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: Accepting Medicare Assignments 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 |