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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MR. BRUCE L JACKSON P.A.
NPI 1124072087
Physician Assistant - Medical in Apple Valley, CA

Active since May 22, 2006PECOS Enrolled
15863 KASOTA RD, APPLE VALLEY, CA 92307(760) 948-1454(760) 948-6100 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Bruce L Jackson P.a. NPPES

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

MR. BRUCE L JACKSON P.A. (NPI 1124072087) is an individual medical provider in Apple Valley, California, licensed in California (PA14185) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS and is a graduate of University Of Southern California Keck School Of Medicine (1994).

NPPES Registry Identity

NPI1124072087
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameMR. BRUCE L JACKSONCredential: P.A.
Location Address15863 KASOTA RDApple Valley, CA 92307-4507
Mailing Address11919 Hesperia RdHesperia, CA 92345-1855 · (760) 948-1454 · Fax (760) 948-6100
Phone(760) 948-1454
Fax(760) 948-6100
Sole ProprietorNo
Medical School CMSUniversity Of Southern California Keck School Of MedicineGraduated 1994
Enumeration DateMay 22, 2006
Last NPPES UpdateJuly 13, 2026
✔ NPI 1124072087 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in CA · PA14185
15863 KASOTA RD, Apple Valley, CA 92307
Open in Google Maps ↗

Other Identifiers 1

MedicaidGR0050902CA

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Bruce L Jackson P.a. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3375642481
PECOS Enrollment IDI20070629000402
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.

Other Providers at the Same Location NPPES 5

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

DESERT FAMILY PRACTICE ASSOCIATES
Family Medicine
15863 KASOTA RD
APPLE VALLEY, CA 92307
San Bernardino County (760) 256-3864
AFP DRUG STORE INC
Pharmacy (Community/Retail Pharmacy)
15863 KASOTA RD, STE C
APPLE VALLEY, CA 92307
San Bernardino County (760) 242-5452
DR. CRAIG R MUELLER M.D.
Family Medicine
15863 KASOTA RD
APPLE VALLEY, CA 92307
San Bernardino County (760) 948-1454
AFP DRUGSTORE, INC.
Pharmacy (Community/Retail Pharmacy)
15863 KASOTA RD, SUITE C
APPLE VALLEY, CA 92307
San Bernardino County (760) 242-5452
UNICARE COMMUNITY HEALTH CENTER, INC.
Clinic/Center (Federally Qualified Health Center (FQHC))
15863 KASOTA RD
APPLE VALLEY, CA 92307
San Bernardino County (760) 946-1100

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 Bruce Jackson's NPI number?

The NPI number for Bruce Jackson is 1124072087. It was assigned to this individual provider in the NPPES registry on May 22, 2006.

Where is Bruce Jackson located?

Bruce Jackson practices at 15863 Kasota Rd, Apple Valley, CA 92307. The listed phone number is (760) 948-1454.

What is Bruce Jackson's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Bruce Jackson enrolled in Medicare?

Yes. Bruce Jackson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Bruce Jackson was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 25 days 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.