Tracy I Jackson, APRN, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209012646 Issued in IL

Practice address

3333 Central St
Evanston, IL 60201-1150

Phone

(866) 389-2727

NPI assigned

Nov 8, 2010

Last updated

Jul 24, 2023By 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 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Endeavor Health Medical Group

  dba NorthShore University HealthSystem Faculty Practice Associates

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882
  Medicare reassignment NPD
• Minuteclinic Diagnostic of Illinois PLLC

  • Family Nurse Practitioner
  • Mokena, IL
  • NPI 1356485809
  Medicare reassignment NPD
• Evanston Carenow Homecare, LLC

  • In Home Supportive Care Agency
  • Evanston, IL
  • NPI 1588238802
  NPD Authorized official
• Care at Home Mississippi

  • In Home Supportive Care Agency
  • Hattiesburg, MS
  • NPI 1003596008
  NPD Authorized official
• Endeavor Health Medical Group

  dba NorthShore Anesthesia Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD

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

{
    "created_epoch": "1289174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1871894899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 LAKE STREET",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60201",
            "telephone_number": "847-563-0295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 CENTRAL ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011150",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TRACY",
        "middle_name": "I",
        "name_prefix": "Mrs.",
        "credential": "APRN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-08",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041315953",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209012646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lee Jackson, MA, LCPC.
• Katherine A Jackson, OTR/L
• Marcus Jackson
• Robert Jackson, MD
• Steven Jackson
• Dalia T. Jacob, MD
• Jaimy Jacob, APN-CNP
• Beth Jacobs, PH.D.
• Jonker Casper Jacobs, DMD
• Kelly Marie Jacobs, LCSW, PMH-C

• Family Nurse Practitioner in Evanston, IL
• Providers in Evanston, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.