MS. SHANNA SHANEEN JACKSON NP
NPI 1710506472
Nurse Practitioner - Family in Moreno Valley, CA
About Ms. Shanna Shaneen Jackson Np NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MS. SHANNA SHANEEN JACKSON NP (NPI 1710506472) is an individual family provider in Moreno Valley, California, licensed in California (95013739) and active in the NPI registry since April 2020. She is enrolled in Medicare PECOS, maintains a secondary practice location in Moreno Valley, and is a graduate of Other (2021).
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
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
Ms. Shanna Shaneen Jackson Np 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 Reassignment
Medicare enrollment records show Shanna Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Riverside, CA 92505
- Reassigned Medicare billing, California enrollment
- 5,228 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 92553 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 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MORENO VALLEY, CA 92553
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 Shanna Jackson's NPI number?
The NPI number for Shanna Jackson is 1710506472. It was assigned to this individual provider in the NPPES registry on April 13, 2020.
Where is Shanna Jackson located?
Shanna Jackson practices at 24060 Fir Ave Ste A, Moreno Valley, CA 92553. The listed phone number is (951) 247-8005.
What is Shanna Jackson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Shanna Jackson enrolled in Medicare?
Yes. Shanna 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 organization bills Medicare for Shanna Jackson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Shanna Jackson reassigns Medicare benefits to Southern California Permanente Medical Group (Riverside, CA). The 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 Shanna Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Shanna Jackson was last updated on April 26, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Ms. Shanna Shaneen Jackson, NP · NPI 1710506472
Family physician in Moreno Valley, California. Individual provider, active in the CMS NPPES registry since April 13, 2020.
## Identity
- **NPI:** 1710506472 (Entity type: Individual)
- **Enumerated:** April 13, 2020
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 95013739 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 24060 FIR AVE STE A, Moreno Valley, CA 92553-2895
- **Phone:** (951) 247-8005
## 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:** Southern California Permanente Medical Group (NPI 1316979834, Riverside, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** April 26, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1710506472) · Data from the CMS NPPES public registry.