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Active NPI 1053696971 Individual Practitioner Female Practitioner

Carly Anne Jackson , PA-C

Physician Assistant • Rockford, IL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Carly Jackson, PA-C is a certified Physician Assistant practicing in Rockford, IL. With approximately 17 years of clinical experience since graduating from Middlesex University School Of Medicine in 2009, Carly Jackson delivers high-quality medical care to the local community at 324 ROXBURY RD.

Carly Jackson is affiliated with Mid-Columbia Medical Center and accepts Medicare assignment.

Frequently performed procedures and clinical services include new patient outpatient office visit, partial removal of middle spine bone with release of spinal cord and/or nerves, 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

324 Roxbury Rd

Rockford, IL 611075090

Telephone 8153989491
Fax 8153817333
Associated Practice Facility / Clinic
🏢 Orthomidwest, Pllc Facility NPI 1730136474

Medicare Profile & Education

Medical School

Middlesex University School Of Medicine

Graduation Year

2009

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Rockford, IL

Established Specialist (10-20 Yrs)
Practitioner Clinical Experience
17 Yrs +6.4 yrs vs City Avg
City Avg: 10.6 Yrs
State Avg: 11.7 Yrs
Regional Practice Density
115 Specialists

Practicing in Rockford, IL (4958 Statewide)

Telehealth Adoption Rate
5.2% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
86.0% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Jackson (17 Years) 17 Yrs
Rockford Specialty Average (10.6 Years) 10.6 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2017)
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more
22 22 $219.00 $88.94
63047 Partial removal of middle spine bone with release of spinal cord and/or nerves
13 13 $1474.75 $89.19
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
12 12 $214.00 $87.96
22633 Fusion of spine in lower back with partial removal of spine bone and disc
11 11 $1850.00 $260.72

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Hospital & Practice Group Affiliations

Mid-Columbia Medical Center

33 Nichols Pkwy, Hood River, OR 970313121

Phone: 5413081010

Mid-Columbia Medical Center

Po Box, The Dalles, OR 97058

Mid-Columbia Medical Center

1825 E 19th St, The Dalles, OR 970583365

Phone: 5412967811

Mid-Columbia Medical Center

1805 E 19th St, The Dalles, OR 970583365

Phone: 5412962201

Mid-Columbia Medical Center

551 Lone Pine Blvd, The Dalles, OR 970589404

Mid-Columbia Medical Center

1700 E 19th St, The Dalles, OR 970583317

Phone: 5412961111

Practice Associates & Co-Workers

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

40 Associated Practitioners
NPI 1003158403

Doctor of Medicine (M.D.)

Mariola Grzeszczyk , APRN

Nurse Practitioner

NPI 1003425463

Advanced Practice Registered Nurse

NPI 1003856295

Doctor of Medicine (M.D.)

Dr. Douglas Pacaccio , DPM

Podiatrist - Foot & Ankle Surgery

NPI 1013005867

Doctor of Podiatric Medicine

Dr. Kelly Brinkman , DPT

Physical Therapist

NPI 1023398179

Doctor of Physical Therapy

Amanda Foit , NP

Nurse Practitioner

NPI 1023426475

Nurse Practitioner

Career & Practice History Timeline

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

6 Historical Events
NPI Profile Active June 05, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location June 05, 2014

Registered at 324 ROXBURY RD, ROCKFORD, IL 611075090 (Tel: 8153989491)

📍
Updated Business Mailing Address June 05, 2014

Registered at BOX 78534, MILWAUKEE, WI 53278 (Tel: 8153989491)

👤
Provider Name / Credentials Updated June 05, 2014

Recorded as CARLY JACKSON, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 05, 2014

Physician Assistant

🟢
Initial NPI Registration & Enumeration October 12, 2011

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: 1053696971
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 12, 2011
Last Update: June 05, 2014
Sole Proprietor: No

Mailing Address

Box 78534

Milwaukee, WI 53278

Phone: 8153989491

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.