Gracie Ellen Jackson, PMHNP-BC in South Pasadena, CA

Gracie Ellen Jackson, PMHNP-BC is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in South Pasadena, California. Her current practice location is 625 Fair Oaks Ave Ste 300, South Pasadena, California. You can reach out to her office (for appointments etc.) via phone at (626) 441-4221.

Gracie Ellen Jackson is licensed to practice in California (license number NP95015149) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1255956314.

Contact Information

	Gracie Ellen Jackson, PMHNP-BC
	625 Fair Oaks Ave Ste 300, South Pasadena, CA 91030-5805
	(626) 441-4221
	Not Available

Map and Direction

Provider's Profile

Full Name	Gracie Ellen Jackson
Gender	Female
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	625 Fair Oaks Ave Ste 300, South Pasadena, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1255956314
Provider Enumeration Date: 06/14/2020
Last Update Date: 03/11/2024

Medicare PECOS Information:

PECOS PAC ID: 8224429840
Enrollment ID: I20211215001456

Medical Identifiers

Medical identifiers for Gracie Ellen Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1255956314	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	NP95015149 (California)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Gracie Ellen Jackson allows following entities to bill medicare on her behalf.

Entity Name	Pacific Clinics
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1255496105 PECOS PAC ID: 4082008420 Enrollment ID: O20220228001926

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Gracie Ellen Jackson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Gracie Ellen Jackson, PMHNP-BC 625 Fair Oaks Ave Ste 300, South Pasadena, CA 91030-5805 Ph: (626) 441-4221	Gracie Ellen Jackson, PMHNP-BC 625 Fair Oaks Ave Ste 300, South Pasadena, CA 91030-5805 Ph: (626) 441-4221

Reviews and Comments

Nurse Practitioner Nurses in South Pasadena, CA

Mr. Danny Lam, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 855 Monterey Rd, South Pasadena, CA 91030 Phone: 626-673-3650
Matthew Roy Isaacks, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1714 Fair Oaks Ave Apt 3, South Pasadena, CA 91030 Phone: 714-642-0034
Cynthia Cruz-kuang, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1936 Huntington Dr # C, South Pasadena, CA 91030 Phone: 626-288-4878
Josephine Villanueva Crisostomo, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 726 1/2 Brent Ave, South Pasadena, CA 91030 Phone: 626-864-6871
Jennina Manzano, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 209 Fair Oaks Ave, South Pasadena, CA 91030 Phone: 626-396-2900 Fax: 626-799-2889
George Lam, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 625 Fair Oaks Ave, South Pasadena, CA 91030 Phone: 626-441-4221 Fax: 626-799-1009

Gracie Ellen Jackson, PMHNP-BC - Medicare Nurse Practitioner in South Pasadena, CA