| Jackson Medical Group Inc | |
|
517 W Junipero St Santa Barbara CA 93105-4239 | |
| (805) 682-8844 | |
| (805) 682-4735 |
| Full Name | Jackson Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 517 W Junipero St, Santa Barbara, California |
| Authorized Official Name and Position | Karen M Engberg (PRESIDENT) |
| Authorized Official Contact | 8056828844 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Medical Group Inc 517 W Junipero St Santa Barbara CA 93105-4239 Ph: (805) 682-8844 | Jackson Medical Group Inc 517 W Junipero St Santa Barbara CA 93105-4239 Ph: (805) 682-8844 |
| NPI Number | 1891711289 |
|---|---|
| Provider Enumeration Date | 07/15/2006 |
| Last Update Date | 01/17/2014 |
| Medicare PECOS PAC ID | 6103970983 |
|---|---|
| Medicare Enrollment ID | O20090812000935 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891711289 | NPI | - | NPPES |
| 1891711289 | Other | CA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Douglas E Cummings |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407876774 PECOS PAC ID: 6608802574 Enrollment ID: I20050712000714 |
| Provider Name | Shaun S Ehsani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306040712 PECOS PAC ID: 4688746597 Enrollment ID: I20080710000122 |
| Provider Name | Blanca E Fernandez-kline |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679653927 PECOS PAC ID: 6406846161 Enrollment ID: I20090526000091 |
| Provider Name | Nancy E Warner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528088820 PECOS PAC ID: 2062552987 Enrollment ID: I20091226000037 |
| Provider Name | Douglas R Jackson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063432342 PECOS PAC ID: 7517011281 Enrollment ID: I20111216000237 |
| Provider Name | Danica Kari Lomeli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699119511 PECOS PAC ID: 2163720467 Enrollment ID: I20160420001246 |
| Provider Name | Amir-mohammad Jalilian-nosraty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407091010 PECOS PAC ID: 5496994824 Enrollment ID: I20170830001377 |
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