Individual provider Active NPI

Kristen Marie Trulear-Jackson, M.D.

  • Anesthesiology Physician
  • Charlotte, NC
National Provider Identifier
1780999136
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
201401487 Issued in NC
Practice address
1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone
(704) 377-5772
NPI assigned
Aug 10, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 201401487 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Charlotte, NC 28203-5812

Mailing address

6135 Park South Dr Ste 510
Charlotte, NC 28210-0100
Phone (704) 749-3116

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20141014002069 NC Practitioner - Anesthesiology 5092952705 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Howard University College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHS Anesthesia Services Group IncGroup PAC ID 5799007324, 742 clinicians

Practice addresses (Care Compare)

8800 N Tryon St
Charlotte, NC 28262-3300
Phone (704) 863-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
201401487NCMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Anesthesiology Consultants, PLLC Anesthesiology CurrentSince Aug 29, 2014 Accepting new patients
Morganton Anesthesia Partners, PLLC Anesthesiology CurrentSince Aug 15, 2021 Accepting new patients
Providence Anesthesiology Associates, P.a. Anesthesiology CurrentSince Nov 1, 2020 Accepting new patients
Morganton Anesthesia Partners, PLLC Anesthesiology Current Accepting new patients
Southeast Anesthesiology Consultants, PLLC Anesthesiology CurrentSince Aug 29, 2014 Accepting new patients
CHS Anesthesia Services Group Inc Anesthesiology CurrentSince Dec 15, 2015 Accepting new patients

Locations

131 Providence Rd
Ste 200
Charlotte, NC 28207
Phone 70474958001101

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1918 Randolph Rd
Ste 740
Charlotte, NC 28207
Phone (704) 316-0810

927 East Blvd
Charlotte, NC 28203
Phone (704) 348-1855

16455 Statesville Rd
Huntersville, NC 28078
Phone (704) 801-3719

2201 S Sterling St
Morganton, NC 28655
Phone (828) 580-6393

Interoperability endpoints

  • Direct secure messaging: kjackson621865@carolinashealthcaresystem.direct-ci.com
  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 6

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": "1281398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1780999136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6135 PARK SOUTH DR STE 510",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282100100",
            "telephone_number": "704-749-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-377-5772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRULEAR-JACKSON",
        "first_name": "KRISTEN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-10",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "201401487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.