Jackson Shampo
NPI 1104400027 · Student in an Organized Health Care Education/Training Program · New Haven, CT
Enrolled with Medicare as Order and Referring Only - Emergency Medicine · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Jackson Shampo is a Student in an Organized Health Care Education/Training Program provider in New Haven, CT (NPI 1104400027).
Provider details
- NPI number
- 1104400027
- Entity type
- Individual
- Primary specialty
- Student in an Organized Health Care Education/Training ProgramStudent, Health Care
- Sex
- Male
- Sole proprietor
- No
Specialties & taxonomies
Student, Health Care
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
83% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (1)
- 11175 Campus StLoma Linda, CA 92350-1700Phone: (909) 558-4729
Registry dates
- Enumerated
- 2021-05-06
- Last updated
- 2022-05-02
- Certified
- 2022-05-02
Frequently asked questions
- What is Jackson Shampo's NPI number?
- Jackson Shampo's National Provider Identifier (NPI) is 1104400027, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Jackson Shampo's specialty?
- Jackson Shampo is listed in the NPPES registry with a primary specialty of Student in an Organized Health Care Education/Training Program (Student, Health Care).
- Where is Jackson Shampo located?
- Jackson Shampo's practice location on file with NPPES is 20 York St, New Haven, CT 06510-3220.
- What is Jackson Shampo's phone number?
- The practice phone number listed in the NPPES registry for Jackson Shampo is (203) 688-4242.
- Does Jackson Shampo accept Medicare?
- Jackson Shampo is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Is Jackson Shampo's NPI active?
- Yes — Jackson Shampo's NPI (1104400027) is active in the NPPES registry as of the last update on 2022-05-02.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.