Tracey L Jackson, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

104201 Issued in MO

Practice address

615 S New Ballas Rd
Sjmmc Dept of Anes
Saint Louis, MO 63141-8221

Phone

(636) 386-9224

Fax

(636) 386-7679

NPI assigned

Aug 11, 2005

Last updated

Jul 1, 2026By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gateway Gastroenterology IncGroup PAC ID 2668448713, 25 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

63.97 of 100Reported as group

Quality

79.89

Promoting interoperability

0

Improvement activities

40

Cost

83.34

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

Practice roles

Locations

Interoperability endpoints

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

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.

• Gateway Gastroenterology Inc

  • Specialist
  • Chesterfield, MO
  • NPI 1043250400
  Medicare reassignment Care Compare group NPD
• Comprehensive Anesthesia Care PC

  • Anesthesiology Physician
  • Chesterfield, MO
  • NPI 1215975156

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Mason Ridge Ambulatory Surgery Center LP

  dba Gateway Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Chesterfield, MO
  • NPI 1821453796
  NPD (past)
• Northwest Anesthesia LTD

  • Anesthesiology Physician
  • Bridgeton, MO
  • NPI 1114917374
  NPD (past)
• Physician Anesthesia Services, LLC

  • Anesthesiology Physician
  • Chesterfield, MO
  • NPI 1558456970
  NPD (past)

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782864000000",
    "number": "1902808868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 CONSORT DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114439",
            "telephone_number": "636-386-9224",
            "fax_number": "636-386-7679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "address_2": "SJMMC DEPT OF ANES",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "636-386-9224",
            "fax_number": "636-386-7679"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17298 N Outer 40 Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Chesterfield",
            "state": "MO",
            "postal_code": "630051456",
            "country_code": "US",
            "telephone_number": "314-529-4900",
            "fax_number": "314-434-2679",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TRACEY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-11",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "104201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "915005615",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammera Jackson, LPC
• Tawanna Odelia Jackson
• Teppie Jackson
• Terri Jackson, CRNA
• Tiffany Chavon Jackson
• Travis Wiley Jackson, MD
• Yolunda Dechelle Jackson
• Ziday Jackson
• Ronald Richard Jackups Jr., MD
• Jacob Briegleb, LLC

• Certified Registered Nurse Anesthetist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Certified Registered Nurse Anesthetist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.