Shannon E Jackson, MD - Medicare Internal Medicine in Portland, OR

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Shannon E Jackson, MD is a medicare enrolled "Internal Medicine" physician in Portland, Oregon. She went to Loma Linda University School Of Medicine and graduated in 2003 and has 21 years of diverse experience with area of expertise as Internal Medicine. She is a member of the group practice Providence Health And Services Oregon, Providence Health And Services - Washington, Providence Health And Services Washington and her current practice location is 4805 Ne Glisan St, Portland, Oregon. You can reach out to her office (for appointments etc.) via phone at (503) 215-2393.

Shannon E Jackson is licensed to practice in Oregon (license number MD25874) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1558301168.

Contact Information

Shannon E Jackson, MD
4805 Ne Glisan St,
Portland, OR 97213-2933
(503) 215-2393
Not Available

Map and Direction




Physician's Profile

Full NameShannon E Jackson
GenderFemale
SpecialityInternal Medicine
Experience21 Years
Location4805 Ne Glisan St, Portland, Oregon
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Shannon E Jackson attended and graduated from Loma Linda University School Of Medicine in 2003
  NPI Data:
  • NPI Number: 1558301168
  • Provider Enumeration Date: 06/08/2006
  • Last Update Date: 03/18/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 0446352827
  • Enrollment ID: I20070305000236

Medical Identifiers

Medical identifiers for Shannon E Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1558301168NPI-NPPES
028116MedicaidOR

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207R00000XInternal Medicine MD25874 (Oregon)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Providence Portland Medical CenterPortland, ORHospital
Providence St Peter HospitalOlympia, WAHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Providence Health And Services Oregon06481836081344
Providence Health And Services - Washington2860552973228
Providence Health And Services Washington6709782600387

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shannon E Jackson allows following entities to bill medicare on her behalf.
Entity NameProvidence Health & Services Oregon
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1023488343
PECOS PAC ID: 0648183608
Enrollment ID: O20031106000652
Entity NameProvidence Health & Services Oregon
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1093976243
PECOS PAC ID: 3476450560
Enrollment ID: O20031217000186
Entity NameProvidence Health & Services Oregon
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1568547503
PECOS PAC ID: 5294623245
Enrollment ID: O20040310000315
Entity NameProvidence Health & Services - Washington
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1922259738
PECOS PAC ID: 2860552973
Enrollment ID: O20120906000842
Entity NameProvidence Health & Services- Washington
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1124270715
PECOS PAC ID: 8325100480
Enrollment ID: O20190103000011
Entity NameProvidence Health & Services- Washington
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1093956278
PECOS PAC ID: 1557408176
Enrollment ID: O20190115002109
Entity NameProvidence Health & Services Washington
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1174744304
PECOS PAC ID: 6709782600
Enrollment ID: O20190122003294
Entity NameProvidence Health & Services Mt
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1215222617
PECOS PAC ID: 6608786306
Enrollment ID: O20190125001690
Entity NameProvidence Health & Services Washington
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1194099390
PECOS PAC ID: 0345139929
Enrollment ID: O20190128001785

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shannon E Jackson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Shannon E Jackson, MD
Po Box 3158,
Portland, OR 97208-3158

Ph: () -		Shannon E Jackson, MD
4805 Ne Glisan St,
Portland, OR 97213-2933

Ph: (503) 215-2393

Reviews and Comments


Internal Medicine Doctors in Portland, OR

Salona Shrestha, MD
Internal Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 4805 Ne Glisan St, Portland, OR 97213
Phone: 503-215-2392    
Dr. Emmanuel Trungtoan Tavan, MD
Internal Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 2800 N Vancouver Ave, Suite 230, Portland, OR 97227
Phone: 503-413-2901    
Ginevra Lois Liptan, M.D.
Internal Medicine
Medicare: Not Enrolled in Medicare
Practice Location: 6400 Sw Canyon Ct, Ste 100, Portland, OR 97221
Phone: 503-477-9616    Fax: 503-477-9808
Donald Richard Sullivan, MD
Internal Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 3181 Sw Sam Jackson Park Rd, Uhn67, Portland, OR 97239
Phone: 503-494-6949    
Dr. Victor Nguyen Pham, M.D.
Internal Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 9205 Sw Barnes Rd, Portland, OR 97225
Phone: 503-216-2906    
Richa Uppal, MD
Internal Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 800 Sw 13th Ave, Portland, OR 97205
Phone: 503-221-0161    Fax: 503-274-1697
Reem Hasan, MD
Internal Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 3181 Sw Sam Jackson Park Rd, Ppv 350, Portland, OR 97239
Phone: 503-494-8562    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.