Jackson Taravine Sr
NPI 1467316042ActiveOrganization· Physician Assistant, Medical· Chandler, AZ
Physician Assistant, Medical in Chandler, Arizona, registered in NPPES in December 2025. The authorized official on file is Jackson Taravine, PA, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1467316042 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 9, 2025 |
| Last updated in NPPES | Mar 3, 2026 |
| Certified by provider | Mar 3, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant, Medical Primary | 363AM0700X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (AZ) |
|---|
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