SHANNON E JACKSON MD
NPI 1558301168
Internal Medicine in Portland, OR
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
Specialties & Licenses
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
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.
Medicare Billing Reassignments
8Medicare enrollment records show Shannon Jackson reassigns Medicare billing to 8 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Portland, OR 97213
- Reassigned Medicare billing, Oregon enrollment
- 1,501 clinicians in this Medicare group
Olympia, WA 98506
- Reassigned Medicare billing, Oregon enrollment
- 27 clinicians in this Medicare group
Everett, WA 98201
- Reassigned Medicare billing, Oregon enrollment
- 23 clinicians in this Medicare group
Walla Walla, WA 99362
- Reassigned Medicare billing, Oregon enrollment
- 23 clinicians in this Medicare group
Medford, OR 97504
- Reassigned Medicare billing, Oregon enrollment
- 311 clinicians in this Medicare group
Spokane, WA 99204
- Reassigned Medicare billing, Oregon enrollment
- 23 clinicians in this Medicare group
Missoula, MT 59802
- Reassigned Medicare billing, Oregon enrollment
- 21 clinicians in this Medicare group
Anchorage, AK 99508
- Reassigned Medicare billing, Oregon enrollment
- 22 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
Hospital Affiliations CMS Care Compare 4
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, ORProvidence Portland Medical Center
Acute Care Hospitals · Portland, ORProvidence Milwaukie Hospital
Acute Care Hospitals · Milwaukie, ORProvidence Seaside Hospital
Critical Access Hospitals · Seaside, ORPhysician 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.
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.
PORTLAND, OR 97213
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.
Which organizations bill Medicare for Shannon Jackson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Shannon Jackson reassigns Medicare benefits to 8 organizations: Providence Health & Services - Oregon (Portland, OR), Providence Health & Services Washington (Olympia, WA), Providence Health & Services- Washington (Everett, WA), Providence Health & Services - Washington (Walla Walla, WA), Providence Health & Services - Oregon (Medford, OR) and 3 more organizations, listed in the Medicare section above. Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shannon Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Shannon Jackson accept?
Health plans from Blue Cross and Blue Shield of Montana, Moda Health Plan, Inc., Mountain Health CO-OP and Premera Blue Cross Blue Shield of Alaska 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 and Providence Seaside 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.
# Shannon E Jackson, MD · NPI 1558301168
Internal Medicine physician in Portland, Oregon. Individual provider, active in the CMS NPPES registry since June 8, 2006.
## Identity
- **NPI:** 1558301168 (Entity type: Individual)
- **Enumerated:** June 8, 2006
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **State license:** MD25874 (Oregon)
- **Sole proprietor:** No
## Practice location
- **Address:** 4805 NE GLISAN ST, Portland, OR 97213-2933
- **Phone:** (503) 215-2393
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 8 organizations under Medicare reassignment (form CMS-855R): Providence Health & Services - Oregon (NPI 1316197692, Portland, OR); Providence Health & Services Washington (NPI 1174744304, Olympia, WA); Providence Health & Services- Washington (NPI 1124270715, Everett, WA); Providence Health & Services - Washington (NPI 1922259738, Walla Walla, WA); Providence Health & Services - Oregon (NPI 1093976243, Medford, OR); and 3 more · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Loma Linda University School Of Medicine, class of 2003
## Record status
- **NPPES last updated:** March 18, 2021
- **Other identifiers:** Medicaid 028116 (OR)
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Source: [NPI Profile](https://npiprofile.com/npi/1558301168) · Data from the CMS NPPES public registry.