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MS. SHANNA SHANEEN JACKSON NP
NPI 1710506472
Nurse Practitioner - Family in Moreno Valley, CA

Active since April 13, 2020PECOS EnrolledAccepts Medicare Assignment
24060 FIR AVE STE A, MORENO VALLEY, CA 92553(951) 247-8005 Get Directions Write a Review

NPPES record last updated: April 26, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 26, 2022, Feb 15, 2022, Jan 18, 2021 and 1 more (4 updates tracked since 2020).

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

NPI1710506472
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMS. SHANNA SHANEEN JACKSONCredential: NP
Location Address24060 FIR AVE STE AMoreno Valley, CA 92553-2895
Mailing Address25315 Moorland RdMoreno Valley, CA 92551-9277 · (323) 422-4640
Phone(951) 247-8005
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateApril 13, 2020
Last NPPES UpdateApril 26, 20224 updates tracked since enumeration
NPPES CertifiedFebruary 15, 2022
✔ NPI 1710506472 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in CA · 95013739
Also ListedRegistered NurseTaxonomy 163W00000X · License 755399 (CA)
24060 FIR AVE STE A, Moreno Valley, CA 92553
Open in Google Maps ↗

Secondary Practice Location 1

Location 112815 Heacock StMoreno Valley, CA 92553-3116 · Phone (951) 601-6149 · Fax (951) 601-6036

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

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.

PECOS PAC ID3577959402
PECOS Enrollment IDI20220401001209
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 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.

New Patient
$91.88 typical visit price
range $59.60 – $179.42
Typical copayment $22.97 (range $14.90 – $44.85)
Most-billed visit code 99203
Established Patient
$104.64 typical visit price
range $19.37 – $146.42
Typical copayment $26.16 (range $4.84 – $36.60)
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 3

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

HENNA MOHAMMAD
Physician Assistant
24060 FIR AVE STE A
MORENO VALLEY, CA 92553
Riverside County (951) 247-8005
DIVINE OLUWATOSIN OJELADE NP
Nurse Practitioner (Family)
24060 FIR AVE STE A
MORENO VALLEY, CA 92553
Riverside County (951) 247-8005
HEACOCK HEALTH MEDICAL GROUP, INC.
Clinic/Center (Urgent Care)
24060 FIR AVE STE A
MORENO VALLEY, CA 92553
Riverside County (951) 247-8005

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.

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.