1. Home
  2. Directory
  3. California
  4. Roseville
  5. Pediatrics
  6. NPI Profile

STEPHANIE JACKS
NPI 1003041567
Pediatrics in Roseville, CA

Active since May 27, 2009PECOS Enrolled
2120 PROFESSIONAL DR, ROSEVILLE, CA 95661(916) 771-7700 Get Directions Write a Review

NPPES record last updated: July 8, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 8, 2026, Dec 17, 2021, Aug 1, 2017 (3 updates tracked since 2017).

About Stephanie Jacks NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STEPHANIE JACKS (NPI 1003041567) is an individual pediatrics provider in Roseville, California, licensed in Texas (R4401) and active in the NPI registry since May 2009. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1003041567
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameSTEPHANIE JACKS
Location Address2120 PROFESSIONAL DRRoseville, CA 95661-3700
Mailing Address2120 Professional DrRoseville, CA 95661-3700 · (916) 771-7700
Phone(916) 771-7700
Sole ProprietorNo
Enumeration DateMay 27, 2009
Last NPPES UpdateJuly 8, 20263 updates tracked since enumeration
NPPES CertifiedJuly 8, 2026
✔ NPI 1003041567 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in TX · R4401
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Also ListedDermatologyTaxonomy 207N00000X · License R4401 (TX)
2120 PROFESSIONAL DR, Roseville, CA 95661
Open in Google Maps ↗

Other Identifiers 2

OtherP01500386MS · Railroad Medicare Ptan
Medicaid06536832MS

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Stephanie Jacks is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Stephanie Jacks reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Permanente Medical Group Inc
50 mi
Internal Medicine
7373 WEST LANE
Stockton, CA 95210
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1548343510 (209) 476-2000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95661 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$92.61 typical visit price
range $60.44 – $180.85
Typical copayment $23.15 (range $15.11 – $45.21)
Most-billed visit code 99203
Established Patient
$105.95 typical visit price
range $19.88 – $148.15
Typical copayment $26.48 (range $4.97 – $37.03)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CHRISTINE BADGWELL DOHERTY M.D.
Dermatology
2120 PROFESSIONAL DR
ROSEVILLE, CA 95661
Placer County (916) 631-3010
DAWN ZHAO DPT
Physical Therapist
2120 PROFESSIONAL DR
ROSEVILLE, CA 95661
Placer County (916) 631-3010
DR. SEAN DAVID DOHERTY M.D.
Dermatology
2120 PROFESSIONAL DR
ROSEVILLE, CA 95661
Placer County (916) 631-3010
JEAN LAI M.D.
Physical Medicine & Rehabilitation
2120 PROFESSIONAL DR
ROSEVILLE, CA 95661
Placer County (916) 771-6611
DR. ADAM ADAIR PETTEY M.D.
Dermatology
2120 PROFESSIONAL DR
ROSEVILLE, CA 95661
Placer County (916) 771-6662
PROF. MAN HAN
Acupuncturist
2120 PROFESSIONAL DR, SUITE 135
ROSEVILLE, CA 95661
Placer County (916) 771-6605
EDITH MARION HIGGINS L. AC.
Acupuncturist
2120 PROFESSIONAL DR, SUITE 210
ROSEVILLE, CA 95661
Placer County (916) 771-6619
DR. CHRISTOPHER KEVIN CHIU MD
Surgery
2120 PROFESSIONAL DR
ROSEVILLE, CA 95661
Placer County (267) 257-7600

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stephanie Jacks's NPI number?

The NPI number for Stephanie Jacks is 1003041567. It was assigned to this individual provider in the NPPES registry on May 27, 2009.

Where is Stephanie Jacks located?

Stephanie Jacks practices at 2120 Professional Dr, Roseville, CA 95661. The listed phone number is (916) 771-7700.

What is Stephanie Jacks's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Stephanie Jacks enrolled in Medicare?

Yes. Stephanie Jacks is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Stephanie Jacks's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Stephanie Jacks reassigns Medicare benefits to Permanente Medical Group Inc (Stockton, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Stephanie Jacks's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Stephanie Jacks was last updated on July 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.