Individual provider Active NPI

Chelsea Alane Jackson, PA

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1881075661
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2015007657 Issued in MO
Practice address
510 S Kingshighway Blvd
Dept Radiology
Saint Louis, MO 63110-1016
Phone
(314) 362-7200
Fax
(314) 747-4189
NPI assigned
Jun 17, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2015007657 MO Primary

Addresses

Primary practice location

510 S Kingshighway Blvd
Dept Radiology
Saint Louis, MO 63110-1016

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-7200

Other identifiers 1

IdentifierTypeStateIssuer
220100264MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20210913000564 MO Practitioner - Physician Assistant 1850607433 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Saint Louis University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, shared by 49 NPIs, 2,968 clinicians

Practice addresses (Care Compare)

1 Barnes Jew Hosp PLZ
Saint Louis, MO 63110-1003

510 S Kingshighway Blvd
Saint Louis, MO 63110-1016

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2015007657MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Sep 1, 2021 Accepting new patients
Washington University CurrentSince Sep 1, 2021 Accepting new patients

Locations

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

660 S Euclid Ave
#8131
Saint Louis, MO 63110
Phone (314) 362-2809

510 S Kingshighway Blvd
Saint Louis, MO 63110
Phone (314) 362-0177

660 S Euclid Ave
Saint Louis, MO 63110

660 S Euclid Ave
#8127
Saint Louis, MO 63110
Phone (314) 362-7617

8 Millstone Campus Dr
Saint Louis, MO 63146
Phone (314) 273-4375

4921 Parkview Pl
Ste 13B
Saint Louis, MO 63110
Phone (314) 747-7300

Organizations & group practices 3

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": "1434499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1881075661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-7200",
            "fax_number": "314-747-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 S KINGSHIGHWAY BLVD",
            "address_2": "DEPT RADIOLOGY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101016",
            "telephone_number": "314-362-7200",
            "fax_number": "314-747-4189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHELSEA",
        "middle_name": "ALANE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-17",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2015007657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220100264",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "510 S Kingshighway Blvd",
            "address_2": "Dept Radiology",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.