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JERILYN DE VON JACKSON M.D.
NPI 1962446575
Emergency Medicine in Santa Rosa, CA

Active since June 15, 2006PECOS Enrolled
1110 N DUTTON AVE, SANTA ROSA, CA 95401(707) 303-3600 Get Directions Write a Review

NPPES record last updated: July 25, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jerilyn De Von Jackson M.d. NPPES

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

JERILYN DE VON JACKSON M.D. (NPI 1962446575) is an individual emergency medicine provider in Santa Rosa, California, licensed in California (G67649) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS and maintains a secondary practice location in Santa Rosa.

NPPES Registry Identity

NPI1962446575
Entity TypeIndividualFemale
Primary Taxonomy207P00000X
Provider Legal NameJERILYN DE VON JACKSONCredential: M.D.
Location Address1110 N DUTTON AVESanta Rosa, CA 95401-4606
Mailing Address1772 Piner Rd, Pmb 16Santa Rosa, CA 95403-7401 · (707) 318-9670 · Fax (707) 571-8446
Phone(707) 303-3600
Sole ProprietorNo
Enumeration DateJune 15, 2006
Last NPPES UpdateJuly 25, 2018
✔ NPI 1962446575 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in CA · G67649
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
1110 N DUTTON AVE, Santa Rosa, CA 95401
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Secondary Practice Location 1

Location 13569 Round Barn Cir, Vista Family Health Center, Office GreenSanta Rosa, CA 95403-1757 · Phone (707) 303-3600 ext. 494 · Fax (707) 303-3609

Other Identifiers 1

Medicaid00G676492CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jerilyn De Von Jackson M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 95401 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
$96.16 typical visit price
range $63.04 – $187.01
Typical copayment $24.04 (range $15.76 – $46.75)
Most-billed visit code 99203
Established Patient
$109.88 typical visit price
range $21.02 – $153.40
Typical copayment $27.47 (range $5.25 – $38.35)
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 13

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

EDMEE MARGUERITE DANAN MD
Neuromusculoskeletal Medicine & OMM
1110 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (707) 303-3600
SUZANNE WATTS DEDMORE RN, FNP-C
Nurse Practitioner (Family)
1110 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (707) 303-3600
SANTA ROSA COMMUNITY HEALT CENTERS
Clinic/Center (Federally Qualified Health Center (FQHC))
1110 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (707) 303-3600
CARLO FERRARONE PA-C
Physician Assistant (Medical)
1110 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (707) 396-5151
MARIE MULLIGAN M.D.
Family Medicine
1110 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (707) 303-3600
DEBRA RAWSON
Nurse Practitioner (Family)
1110 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (707) 303-3600
WENDY KOHATSU MD
Family Medicine
1110 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (707) 303-3600
DR. PANNA LOSSY MD
Family Medicine
1110 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (707) 303-3600

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 Jerilyn Jackson's NPI number?

The NPI number for Jerilyn Jackson is 1962446575. It was assigned to this individual provider in the NPPES registry on June 15, 2006.

Where is Jerilyn Jackson located?

Jerilyn Jackson practices at 1110 N Dutton Ave, Santa Rosa, CA 95401. The listed phone number is (707) 303-3600.

What is Jerilyn Jackson's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is Jerilyn Jackson enrolled in Medicare?

Yes. Jerilyn Jackson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jerilyn Jackson was last updated on July 25, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.