Mrs Polly Rebecca Jackson, AG-ACNP - Medicare Nurse Practitioner in Washington, MO

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Mrs Polly Rebecca Jackson, AG-ACNP is a medicare enrolled "Nurse Practitioner - Acute Care" in Washington, Missouri. Her current practice location is 901 E 5th St, Washington, Missouri. You can reach out to her office (for appointments etc.) via phone at (636) 239-8231.

Mrs Polly Rebecca Jackson is licensed to practice in Missouri (license number 2015041436) 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 1790150688.

Contact Information

Mrs Polly Rebecca Jackson, AG-ACNP
901 E 5th St,
Washington, MO 63090-3127
(636) 239-8231
Not Available

Map and Direction




Provider's Profile

Full NameMrs Polly Rebecca Jackson
GenderFemale
SpecialityNurse Practitioner - Acute Care
Location901 E 5th St, Washington, Missouri
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1790150688
  • Provider Enumeration Date: 12/03/2015
  • Last Update Date: 10/25/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 3476845405
  • Enrollment ID: I20160712000500

Medical Identifiers

Medical identifiers for Mrs Polly Rebecca Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1790150688NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LA2100XNurse Practitioner - Acute Care 2015041436 (Missouri)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. Mrs Polly Rebecca Jackson allows following entities to bill medicare on her behalf.
Entity NameMercy Clinic Springfield Communities
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1245277631
PECOS PAC ID: 7416865845
Enrollment ID: O20031104000060
Entity NameMercy Hospitals East Communities
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1427098169
PECOS PAC ID: 1658276811
Enrollment ID: O20031209000789
Entity NameMercy Clinic Springfield Communities
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1972771657
PECOS PAC ID: 7416865845
Enrollment ID: O20031218000354
Entity NameMercy Clinic Palliative Care Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1487815643
PECOS PAC ID: 0941373732
Enrollment ID: O20080728000283
Entity NameMercy Clinic Adult Hospitalists - Washington, Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1891943429
PECOS PAC ID: 3577630540
Enrollment ID: O20080917000782
Entity NameVpa Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1760706337
PECOS PAC ID: 9234041948
Enrollment ID: O20100818000518

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. Mrs Polly Rebecca 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 AddressPractice Location Address
Mrs Polly Rebecca Jackson, AG-ACNP
901 E 5th St,
Washington, MO 63090-3127

Ph: (636) 239-8231		Mrs Polly Rebecca Jackson, AG-ACNP
901 E 5th St,
Washington, MO 63090-3127

Ph: (636) 239-8231

Reviews and Comments


Nurse Practitioner Nurses in Washington, MO

Mrs. Luz Elena Alfonsi, APRN
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 205 Elm St, Suite 202, Washington, MO 63090
Phone: 636-390-4071    Fax: 636-390-8908
Amy Lee Swoboda, FNP-BC
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 901 Patients First Dr, Washington, MO 63090
Phone: 636-239-4100    
Mrs. Ann Marie Hoch, FNP-C
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 851 E 5th St Ste 312, Washington, MO 63090
Phone: 636-390-9100    
Victoria L Yenzer, NP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 901 Patients First Dr, Washington, MO 63090
Phone: 636-239-7500    
Mrs. Sarah Elizabeth Bloch, RN, MSN, FNP
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 901 Patients First Dr, Washington, MO 63090
Phone: 636-390-1400    
Mrs. Lisa Anne Dickinson, FNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 851 E 5th St, Washington, MO 63090
Phone: 636-239-1101    
Corinne Ann Coppinger, RNC, WHNP-BC
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 851 E 5th St, Suite 200, Washington, MO 63090
Phone: 636-239-8585    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.