HALEY W JACKSON (MD) – Family Medicine Physician, NPI 1396248159

HALEY W JACKSON (MD) is a healthcare provider. based in Provo, Utah. specializing in FAMILY PRACTICE. They hold the professional credentials MD. They hold a License No. 11336450-1205 (UT). The NPI Number for HALEY W JACKSON (MD) is 1396248159

Main info

Female
8 Years Of Experience
Accepts Medicare Assignment
Name
HALEY W JACKSON (MD)
NPI
1396248159
Phone
(801) 357-7930
Address
475 W 940 N
Enumeration Date
16 March 2018
Last Update Date
15 July 2021

Doctor Profile

Medical School Name
UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Secondary Phone
8013732001
Graduation Year
2018 (8 years ago)
PAC ID
7012249444
Group Practice PAC ID
7315917697
Professional Enrollment ID
I20191104002377
Address ID
UT846041341PR1900XSTXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience45
Completeness75
Years active:8State licenses:1Digital endpointsOther names

1,136 FAMILY PRACTICE in UT

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Provider Addresses for HALEY W JACKSON (MD)

  • 475, West 940 North, North Park, Provo, Utah County, Utah, 84604, United States

    Provo, UT 846043301

    Phone: (801) 357-7930

    Type: Location

  • 273 N 1325 W

    SPRINGVILLE, UT 846633283

    Phone: (385) 450-4572

    Type: Mailing

  • 1900 N STATE ST

    PROVO, UT 846041341

    Phone: (801) 373-2001

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 50 Open Payments records for all available years, with a total value of $515.

Total Amount is formed as General ($515) + Research ($0) + Ownership ($0) = $515.

Last reported payment date: 2024-11-13 • Largest payer in this snapshot: ABBVIE INC. ($387).

Total Amount

$515

General + Research + Ownership

Payments

50

Total payment records

General Amount

$515

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-13

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2019-11-04

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

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
I20191104002377IFamily PracticeUTTBD

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes8627$0
99213Established patient office or other outpatient visit, 20-29 minutes2214$0
View full utilization report →

Insurance plans in this area (ZIP 84604)

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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: 7315917697View full group profile
NameSpecialtyState
Nurse PractitionerUT
Physician AssistantUT
Nurse PractitionerUT
Family PracticeUT
Nurse PractitionerOR
Physician AssistantUT
Nurse PractitionerUT
-UT
Physician AssistantUT

Reviews

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Frequently asked questions

How do I look up HALEY W JACKSON (MD) by NPI?
Use NPI 1396248159 when you need to reference HALEY W JACKSON (MD) in forms, claims, or directories.
Is HALEY W JACKSON (MD) currently active in the NPI registry?
CMS-published data lists HALEY W JACKSON (MD) as an active registrant.
What field does HALEY W JACKSON (MD) work in?
You can think of HALEY W JACKSON (MD) as practicing within Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What location shows for HALEY W JACKSON (MD)?
We surface Provo, Utah for HALEY W JACKSON (MD) based on available NPPES addresses.
What if Provo, Utah seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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