Tracy P Jackson, MD

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

42636 Issued in TN

Practice address

2960 Camino Diablo Ste 105
Walnut Creek, CA 94597-3945

Phone

(800) 892-2695

NPI assigned

Aug 19, 2006

Last updated

Oct 10, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, CA, OR3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Pain ManagementAlso: Anesthesiology

Education

University of North Carolina at Chapel Hill School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Spine and Sports Specialities Medical GroupGroup PAC ID 6507177367, 15 clinicians

Pain Specialists of Oregon PCGroup PAC ID 4880904176, 3 clinicians

Recover Together IncGroup PAC ID 7810247533, 141 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GHBABD
• FHIR API: https://fhir4.healow.com/fhir/r4/GHBABD/Endpoint/GHBABD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spine and Sports Specialities Medical Group

  • Orthopaedic Surgery Physician
  • Orange, CA
  • NPI 1013306174

  Pain Medicine

  Medicare reassignment Care Compare group NPD
• Pain Specialists of Oregon PC

  • Pain Medicine Physician
  • Eugene, OR
  • NPI 1760853675
  Medicare reassignment Care Compare group NPD
• Recover Together, Inc.

  dba Groups Recover Together

  • Adult Mental Health Clinic/Center
  • London, KY
  • NPI 1346736758

  TN

  Medicare reassignment Care Compare group NPD
• Grand Anesthesiology Services PC

  • Anesthesiology Physician
  • Jackson, WY
  • NPI 1477567246
  NPD (past)
• Pain Consultants of Oregon PC

  dba Oregon Analytic LLC

  • Clinical Medical Laboratory
  • Eugene, OR
  • NPI 1245587674
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1154436590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 THOMPSON LN STE 22209",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372044692",
            "telephone_number": "615-322-4311",
            "fax_number": "615-322-9089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 CAMINO DIABLO STE 105",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945973945",
            "telephone_number": "800-892-2695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TRACY",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A97159",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NC",
            "license": "200300358",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "TN",
            "license": "42636",
            "primary": true
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "TN",
            "license": "42636",
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "CA",
            "license": "A97159",
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "NC",
            "license": "200300358",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roujin Jabbari, PSYD
• Hani R. Jabbour, DMD
• Cynthia Kay Jackson-Burns
• Alexis Kendall Jackson
• Karrin Lynise Jackson, LMP
• Victoria Jackson
• Paige Jaco, LCSW
• Brenda Jacobo
• Betsy A Jacobs, M.D.
• Emma Jacobs

• Pain Medicine (Anesthesiology) Physician in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Pain Medicine (Anesthesiology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.