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DR. RICHARD FREDRICK JACKSON DD.S.
NPI 1124116066
Dentist - Oral and Maxillofacial Surgery in Roseville, CA

Active since October 10, 2006Opted out of Medicare · through Jul 1, 2028
1441 SECRET RAVINE PKWY, SUITE 160, ROSEVILLE, CA 95661(916) 787-1515(916) 787-1516 Get Directions Write a Review

NPPES record last updated: June 5, 2015. Verified against the NPPES registry weekly; last sync: September 13, 2026.

About Dr. Richard Fredrick Jackson Dd.s. NPPES

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

DR. RICHARD FREDRICK JACKSON DD.S. (NPI 1124116066) is an individual oral and maxillofacial surgery provider in Roseville, California, licensed in California (24465) and active in the NPI registry since October 2006. He has opted out of Medicare through July 1, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1124116066
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameDR. RICHARD FREDRICK JACKSONCredential: DD.S.
Location Address1441 SECRET RAVINE PKWY, SUITE 160Roseville, CA 95661-6044
Mailing Address1441 Secret Ravine Pkwy, Suite 160Roseville, CA 95661-6044 · (916) 787-1515 · Fax (916) 787-1516
Phone(916) 787-1515
Fax(916) 787-1516
Sole ProprietorYes
Enumeration DateOctober 10, 2006
Last NPPES UpdateJune 5, 2015
✔ NPI 1124116066 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in CA · 24465
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
1441 SECRET RAVINE PKWY, Roseville, CA 95661
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Richard Fredrick Jackson Dd.s. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 1, 2018 through July 1, 2028.

Opt-Out Effective DateJuly 1, 2018
Opt-Out In Effect ThroughJuly 1, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

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
$75.03 typical visit price
range $19.88 – $148.15
Typical copayment $18.75 (range $4.97 – $37.03)
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 8

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

WILLIAM J BOHAN DMD
Dentist (General Practice)
1441 SECRET RAVINE PKWY, #100
ROSEVILLE, CA 95661
Placer County (916) 782-7783
STUART E WAKEMAN DDS
Dentist (General Practice)
1441 SECRET RAVINE PKWY, #100
ROSEVILLE, CA 95661
Placer County (916) 782-7783
DAVID G CERNIK DDS
Dentist (General Practice)
1441 SECRET RAVINE PKWY, #100
ROSEVILLE, CA 95661
Placer County (916) 782-7783
KRESTON ANDERSON DDS
Dentist (General Practice)
1441 SECRET RAVINE PKWY, #100
ROSEVILLE, CA 95661
Placer County (916) 782-7783
DR. SCOTT EVERETTE ZAWADA DC
Chiropractor
1441 SECRET RAVINE PKWY, STE 140
ROSEVILLE, CA 95661
Placer County (916) 773-0999
GARY CLAUDE YEATTS LCSW
Social Worker (Clinical)
1441 SECRET RAVINE PKWY, SUITE 140
ROSEVILLE, CA 95661
Placer County (916) 202-3646
ZAWADA CHIROPRACTIC INC.
Chiropractor
1441 SECRET RAVINE PKWY, SUITE 140
ROSEVILLE, CA 95661
Placer County (916) 773-0999
DR. ALAN C PAN D.D.S.
Dentist (General Practice)
1441 SECRET RAVINE PKWY, SUITE 160
ROSEVILLE, CA 95661
Placer County (916) 781-6688

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 Richard Jackson's NPI number?

The NPI number for Richard Jackson is 1124116066. It was assigned to this individual provider in the NPPES registry on October 10, 2006.

Where is Richard Jackson located?

Richard Jackson practices at 1441 Secret Ravine Pkwy Suite 160, Roseville, CA 95661. The listed phone number is (916) 787-1515.

What is Richard Jackson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Richard Jackson enrolled in Medicare?

No. Richard Jackson has opted out of Medicare through July 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Richard Jackson was last updated on June 5, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.