Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1093724551 Individual Practitioner Male Practitioner

Dr. Jon C Jackson , MD

Specialist • Port Orange, FL

Professional Overview & Biography Verified Profile Summary

Dr. Jon Jackson, MD is a registered healthcare professional specializing in Specialist in Port Orange, FL. Practice services are available at 4770 S RIDGEWOOD AVE under active NPI credentials.

Frequently performed procedures and clinical services include established patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

4770 S Ridgewood Ave

Port Orange, FL 321274544

Telephone 3867610050
Fax 3867611167
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Port Orange, FL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 37.8 Yrs
Regional Practice Density
9 Specialists

Practicing in Port Orange, FL (3036 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
19.9% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2019)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
15 15 $134.45 $107.70

Medical Specialties & State Licenses

Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

State License FL ME28054

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Blue Cross Blue Shield
64353 (FL)
Commercial Insurance / Payer ID Cigna
013 (FL)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners
Margaret Peck , ARNP, FNP-BC

Nurse Practitioner - Family

NPI 1083046346

Advanced Registered Nurse Practitioner, Family Nurse Practitioner (Board Certified)

Cassandra Warner , APRN

Nurse Practitioner - Family

NPI 1124787742

Advanced Practice Registered Nurse

Rachael Hammel , NP

Nurse Practitioner - Family

NPI 1164149357

Nurse Practitioner

Vickie Sorrell , FNP-BC

Nurse Practitioner - Family

NPI 1306114483

Family Nurse Practitioner (Board Certified)

Dr. Diana Mendez , MD

Internal Medicine

NPI 1801852439

Doctor of Medicine (M.D.)

NPI 1912985789

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 09, 2007

Registered at 4770 S RIDGEWOOD AVE, PORT ORANGE, FL 321274544 (Tel: 3867610050)

📍
Updated Business Mailing Address July 09, 2007

Registered at 4770 S RIDGEWOOD AVE, PORT ORANGE, FL 321274544 (Tel: 3867610050)

👤
Provider Name / Credentials Updated July 09, 2007

Recorded as JON JACKSON, M.D.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Specialist (License #ME28054 in FL)

🟢
Initial NPI Registration & Enumeration August 05, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1093724551
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 05, 2006
Last Update: July 09, 2007
Sole Proprietor: Yes

Mailing Address

4770 S Ridgewood Ave

Port Orange, FL 321274544

Phone: 3867610050

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.