Individual provider Active NPI

Matt Jackson, AGAC NP- BC

  • Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1619419793
Registry record updated Jan 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209015073 Issued in IL
Practice address
676 N Saint Clair St Ste 650
Chicago, IL 60611-2929
Phone
(312) 695-3800
Fax
(312) 695-3644
NPI assigned
Nov 7, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209015073 IL Primary
Acute Care Nurse Practitioner 363LA2100X 209.015073 IL

Addresses

Primary practice location

676 N Saint Clair St Ste 650
Chicago, IL 60611-2929

Mailing address

676 N Saint Clair St Ste 650
Chicago, IL 60611-2929
Phone (312) 695-3800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161117001247 IL Practitioner - Nurse Practitioner 3870872708 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

1000 N Westmoreland Rd
Pavillion B 3Rd FL
Lake Forest, IL 60045-1659
Phone (847) 535-8500

1000 Westmoreland Rd
Lake Forest, IL 60045-1659
Phone (847) 234-5600

251 E Huron
Chicago, IL 60611-2908

251 E Huron St
Chicago, IL 60611-2908

600 N Westmoreland Rd
Suite 1100
Lake Forest, IL 60045-1659
Phone (847) 535-9510

660 N Westmoreland Rd
Lake Forest, IL 60045-1659
Phone (847) 234-5600

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209015073ILMDNurse Practitioner
209.015073ILMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Group CurrentSince Oct 1, 2020 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Dec 4, 2025 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Dec 4, 2025 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

1725 W Harrison St
Ste 115
Chicago, IL 60612
Phone (312) 829-2540

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

1725 W Harrison St
Ste 1156
Chicago, IL 60612
Phone (312) 563-2762

676 N Saint Clair St
Ste 650
Chicago, IL 60611
Phone (312) 695-3800

75 Remittance Dr
Dept 1611
Chicago, IL 60675

660 N Westmoreland Rd
Lake Forest, IL 60045
Phone (847) 535-6100

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Interoperability endpoints

  • Direct secure messaging: mjackson130303@direct.rush.rush-health.com

Organizations & group practices 4

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769558400000",
    "number": "1619419793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 650",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112929",
            "telephone_number": "312-695-3800",
            "fax_number": "312-695-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 650",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112929",
            "telephone_number": "312-695-3800",
            "fax_number": "312-695-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MATT",
        "credential": "AGAC NP- BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-07",
        "last_updated": "2026-01-28",
        "certification_date": "2026-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209015073",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "209.015073",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.