MR. TIMOTHY LAWRENCE JACKSON (PA) – Medical Physician Assistant, NPI 1124338504
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MR. TIMOTHY LAWRENCE JACKSON (PA)
2722 N MARIAH WAY
FLAGSTAFF, AZ 860047516
Phone: (928) 527-7759
Type: Mailing
2722 N Mariah Way
Flagstaff, AZ 860047550
Phone: (928) 527-7759
Type: Location
PO BOX 3630
FLAGSTAFF, AZ 860033630
Phone:
Type: Mailing
300 S 6TH ST
WILLIAMS, AZ 860460110
Phone: (928) 635-4441
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2013-08-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20110103000130 | I | Physician Assistant | TX | TBD |
| I20130805000444 | I | Physician Assistant | AZ | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99283 | Emergency department visit with low level of medical decision making | 77 | 68 | $0 |
| 99284 | Emergency department visit with moderate level of medical decision making | 34 | 32 | $0 |
Insurance plans in this area (ZIP 86004)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | AZ | 81002 | Urinalysis, manual test | 12 | 12 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology | NM | |
| - | CA | |
| Physician Assistant | FL | |
| Nurse Practitioner | AZ | |
| O P T O M E T R Y | TX | |
| - | AZ | |
| Family Practice | AZ | |
| - | NY | |
| O B S T E T R I C S/ G Y N E C O L O G Y | AZ | |
| Emergency Medicine | IN |
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