STACIE JACKSON PA-C
NPI 1538683909
Physician Assistant in Longmont, CO

Q: What is Stacie Jackson's NPI number?

The NPI number for Stacie Jackson is 1538683909. It was assigned to this individual provider in the NPPES registry on July 27, 2017.

Q: What is Stacie Jackson's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Stacie Jackson was last updated on August 3, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.

Active since July 27, 2017PECOS EnrolledAccepts Medicare Assignment

1630 DRY CREEK DR STE 200, LONGMONT, CO 80503(720) 279-9098(720) 540-4250 Get Directions Write a Review

NPPES record last updated: August 3, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 3, 2021, Mar 17, 2018, Jul 27, 2017 (3 updates tracked since 2017).

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About Stacie Jackson Pa-c NPPES

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

STACIE JACKSON PA-C (NPI 1538683909) is an individual physician assistant in Longmont, Colorado, licensed in Colorado (PA.0005029) and active in the NPI registry since July 2017. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1538683909

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameSTACIE JACKSONCredential: PA-C

Location Address1630 DRY CREEK DR STE 200Longmont, CO 80503-6405

Mailing Address6500 West 29th St Ste 106Greeley, CO 80634-8386 · (970) 330-5555

Phone(720) 279-9098

Fax(720) 540-4250

Sole ProprietorYes

Medical School CMSOtherGraduated 2017

Enumeration DateJuly 27, 2017

Last NPPES UpdateAugust 3, 20213 updates tracked since enumeration

NPPES CertifiedJuly 8, 2021

✔ NPI 1538683909 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in CO · PA.0005029

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

1630 DRY CREEK DR STE 200, Longmont, CO 80503

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

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

Stacie Jackson Pa-c 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 ID8527331073

PECOS Enrollment IDI20170905000730

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 80503 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.

Referred Medical Equipment & Supplies CMS DME claims 11

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Tubing with integrated heating element for use with positive airway pressure device A4604

DME-Other DME · category DE001N

3 suppliers33 claims33 services$38.56 avg. paid by Medicare

Full face mask used with positive airway pressure device, each A7030

DME-Other DME · category DE001N

3 suppliers11 claims11 services$91.24 avg. paid by Medicare

Face mask interface, replacement for full face mask, each A7031

DME-Other DME · category DE001N

1 supplier11 claims25 services$35.40 avg. paid by Medicare

Cushion for use on nasal mask interface, replacement only, each A7032

DME-Other DME · category DE001N

3 suppliers22 claims116 services$19.13 avg. paid by Medicare

Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034

DME-Other DME · category DE001N

3 suppliers30 claims30 services$58.24 avg. paid by Medicare

Headgear used with positive airway pressure device A7035

DME-Other DME · category DE001N

5 suppliers28 claims28 services$19.14 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 7

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

DIANA REYES RPSGT

Technician/Technologist