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STACY MARIE JACKSON DDS
NPI 1043530991
Dentist - Pediatric Dentistry in Boulder, CO

Active since June 02, 2010PECOS Enrolled
3400 PENROSE PL STE 107, BOULDER, CO 80301(303) 443-8250 Get Directions Write a Review

NPPES record last updated: April 26, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 14, 2022, Sep 25, 2019 (2 updates tracked since 2019).

About Stacy Marie Jackson Dds NPPES

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

STACY MARIE JACKSON DDS (NPI 1043530991) is an individual pediatric dentistry provider in Boulder, Colorado, licensed in Colorado (DEN.00202791) and active in the NPI registry since June 2010. She is enrolled in Medicare PECOS and maintains a secondary practice location in Westminster.

NPPES Registry Identity

NPI1043530991
Entity TypeIndividualFemale
Primary Taxonomy1223P0221X
Provider Legal NameSTACY MARIE JACKSONCredential: DDS
Location Address3400 PENROSE PL STE 107Boulder, CO 80301-1809
Mailing Address291 Maddox LaneErie, CO 80516 · (785) 249-2973
Phone(303) 443-8250
Sole ProprietorYes
Enumeration DateJune 2, 2010
Last NPPES UpdateApril 26, 20232 updates tracked since enumeration
NPPES CertifiedApril 26, 2023
✔ NPI 1043530991 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in CO · DEN.00202791
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Also ListedDentistTaxonomy 122300000X · License 2010016174 (MO)
3400 PENROSE PL STE 107, Boulder, CO 80301
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Other Names 1

Former Name (1)Stacy Jackson Ehlers Dds

Secondary Practice Location 1

Location 15150 W 80th AveWestminster, CO 80030-4449 · Phone (303) 427-1951

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Stacy Marie Jackson Dds 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 80301 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
$89.43 typical visit price
range $58.06 – $174.82
Typical copayment $22.35 (range $14.51 – $43.70)
Most-billed visit code 99203
Established Patient
$72.20 typical visit price
range $18.88 – $142.79
Typical copayment $18.05 (range $4.72 – $35.69)
Most-billed visit code 99213
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 2

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

CHILDREN'S DENTISTRY, BOULDER
Dentist (Pediatric Dentistry)
3400 PENROSE PL STE 107
BOULDER, CO 80301
Boulder County (303) 443-8250
DR. ROBERT S PANKRATZ DDS
Dentist (Pediatric Dentistry)
3400 PENROSE PL STE 107
BOULDER, CO 80301
Boulder County (303) 443-8250

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 Stacy Jackson's NPI number?

The NPI number for Stacy Jackson is 1043530991. It was assigned to this individual provider in the NPPES registry on June 2, 2010. The provider is also known as Stacy Jackson Ehlers Dds.

Where is Stacy Jackson located?

Stacy Jackson practices at 3400 Penrose Pl Ste 107, Boulder, CO 80301. The listed phone number is (303) 443-8250.

What is Stacy Jackson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Is Stacy Jackson enrolled in Medicare?

Yes. Stacy Jackson is registered in the Medicare PECOS enrollment system.

What insurance does Stacy Jackson accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 6 other insurers list Stacy Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Stacy Jackson was last updated on April 26, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.