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SHANNON E JACKSON MD
NPI 1558301168
Internal Medicine in Portland, OR

Active since June 08, 2006PECOS EnrolledAccepts Medicare Assignment
4805 NE GLISAN ST, PORTLAND, OR 97213(503) 215-2393 Get Directions Write a Review

NPPES record last updated: March 18, 2021. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Shannon E Jackson Md NPPES

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

SHANNON E JACKSON MD (NPI 1558301168) is an individual internal medicine provider in Portland, Oregon, licensed in Oregon (MD25874) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS, is affiliated with Providence St Vincent Medical Center, and is a graduate of Loma Linda University School Of Medicine (2003).

NPPES Registry Identity

NPI1558301168
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameSHANNON E JACKSONCredential: MD
Location Address4805 NE GLISAN STPortland, OR 97213-2933
Mailing AddressPo Box 3158Portland, OR 97208-3158
Phone(503) 215-2393
Sole ProprietorNo
Medical School CMSLoma Linda University School Of MedicineGraduated 2003
Enumeration DateJune 8, 2006
Last NPPES UpdateMarch 18, 2021
NPPES CertifiedMarch 18, 2021
✔ NPI 1558301168 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in OR · MD25874
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
4805 NE GLISAN ST, Portland, OR 97213
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Other Identifiers 1

Medicaid028116OR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Moda Health Plan, Inc., Premera Blue Cross Blue Shield of Alaska 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 and accepts Medicare assignment

Shannon E Jackson Md 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 ID446352827
PECOS Enrollment IDI20070305000236
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.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
69 services67 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
13 services13 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Providence St Vincent Medical Center

Acute Care Hospitals · Portland, OR
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number380004
Location9205 SW Barnes RoadPortland, OR 97225 · Washington County
Emergency services Birthing friendly

Providence Portland Medical Center

Acute Care Hospitals · Portland, OR
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number380061
Location4805 NE Glisan StreetPortland, OR 97213 · Multnomah County
Emergency services Birthing friendly

Providence Milwaukie Hospital

Acute Care Hospitals · Milwaukie, OR
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number380082
Location10150 SE 32nd AvenueMilwaukie, OR 97222 · Clackamas County

Providence Seaside Hospital

Critical Access Hospitals · Seaside, OR
OwnershipVoluntary non-profit - Church
CMS Certification Number381303
Location725 S Wahanna RoadSeaside, OR 97138 · Clatsop County
Emergency services Birthing friendly

Providence St Peter Hospital

Acute Care Hospitals · Olympia, WA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number500024
Location413 Lilly Road NEOlympia, WA 98506 · Thurston County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97213 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
$134.16 typical visit price
range $58.99 – $176.88
Typical copayment $33.54 (range $14.74 – $44.22)
Most-billed visit code 99204
Established Patient
$103.51 typical visit price
range $19.32 – $144.79
Typical copayment $25.87 (range $4.83 – $36.19)
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 20

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

SALONA SHRESTHA MD
Internal Medicine
4805 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-2392
PROVIDENCE HEALTH & SERVICES - OREGON
General Acute Care Hospital
4805 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 451-3000
DR. ROBERT THOMAS MARTIN M.D.
Emergency Medicine
4805 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 297-6334
CECILIA BRADFORD CRNA
Nurse Anesthetist, Certified Registered
4805 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-1111
PROVIDENCE HEALTH & SERVICES - OREGON
Psychiatric Unit
4805 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-4323
GITA D GELFER DO
Hospitalist
4805 NE GLISAN ST, STE BG05
PORTLAND, OR 97213
Multnomah County (503) 215-2392
MECCA CARTER
Doula
4805 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-1111
JESUS ERNESTO CONRIQUE GARCIA
Nurse's Aide
4805 NE GLISAN ST
PORTLAND, OR 97213
Multnomah County (503) 215-1111

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 Shannon Jackson's NPI number?

The NPI number for Shannon Jackson is 1558301168. It was assigned to this individual provider in the NPPES registry on June 8, 2006.

Where is Shannon Jackson located?

Shannon Jackson practices at 4805 NE Glisan St, Portland, OR 97213. The listed phone number is (503) 215-2393.

What is Shannon Jackson's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Shannon Jackson enrolled in Medicare?

Yes. Shannon 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.

What insurance does Shannon Jackson accept?

Health plans from Blue Cross and Blue Shield of Montana, Moda Health Plan, Inc., Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Shannon 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.

Is Shannon Jackson affiliated with any hospitals?

According to CMS data, Shannon Jackson is affiliated with Providence St Vincent Medical Center, Providence Portland Medical Center, Providence Milwaukie Hospital, Providence Seaside Hospital and Providence St Peter Hospital.

When was this NPI record last updated?

The NPPES record for Shannon Jackson was last updated on March 18, 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.