DR. JACKSON ROOS (MD) – Emergency Medicine Physician, NPI 1023694973

DR. JACKSON ROOS (MD) is a healthcare provider. based in Los angeles, California. specializing in EMERGENCY MEDICINE. They hold the professional credentials MD. They hold a License No. 345649 (LA). The NPI Number for DR. JACKSON ROOS (MD) is 1023694973

Main info

Male
Sole Proprietor
5 Years Of Experience
Accepts Medicare Assignment
Name
DR. JACKSON ROOS (MD)
NPI
1023694973
Phone
(207) 749-7690
Address
1200 N STATE ST # 1060K
Enumeration Date
22 March 2021
Last Update Date
18 June 2025

Doctor Profile

Medical School Name
TULANE UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
6613274647
Graduation Year
2021 (5 years ago)
PAC ID
8628519873
Group Practice PAC ID
7214086321
Professional Enrollment ID
I20241223002809
Address ID
CA933012237BA420XXSTXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience39
Completeness85
Years active:5State licenses:1Digital endpointsOther names

5,791 EMERGENCY MEDICINE in CA

Provider Addresses for DR. JACKSON ROOS (MD)

  • 1200 N STATE ST # 1060K

    LOS ANGELES, CA 900891001

    Phone: (207) 749-7690

    Type: Mailing

  • 1200 N STATE ST

    LOS ANGELES, CA 900891001

    Phone: (207) 749-7690

    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: 2025-04-04

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20241223002809IEmergency MedicineCATBD
I20250404000470IEmergency MedicineLATBD

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.

Verify on CMS Revalidation Lookup Tool

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 90089)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7214086321View full group profile
NameSpecialtyState
Emergency MedicineCA
Emergency MedicineCA
Emergency MedicineCA
Nurse PractitionerCA
Emergency MedicineCA
Emergency MedicineCA
Nurse PractitionerCA
Nurse PractitionerCA
Emergency MedicineCA
Emergency MedicineNC

Reviews

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Frequently asked questions

What unique ID ties claims to DR. JACKSON ROOS (MD)?
NPI 1023694973 is assigned to DR. JACKSON ROOS (MD) under the national enumeration system.
Is DR. JACKSON ROOS (MD) currently active in the NPI registry?
CMS-published data lists DR. JACKSON ROOS (MD) as an active registrant.
What does DR. JACKSON ROOS (MD) treat or focus on?
Patients typically see DR. JACKSON ROOS (MD) under the specialty Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is DR. JACKSON ROOS (MD)'s primary listing?
We display Los Angeles, California because that is what the record indicates for DR. JACKSON ROOS (MD).
Is DR. JACKSON ROOS (MD) a real provider?
This page reflects official NPPES data for NPI 1023694973. Always confirm identity and privileges with the practice and licensing boards.

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