Tanagra Jackson, FNP is a medicare enrolled "Nurse Practitioner" in Nuevo, California. Her current practice location is
30427 Delta Dr, Nuevo, California. You can reach out to her office (for appointments etc.) via phone at
(773) 530-5217.
Tanagra Jackson is licensed to practice in California (license number 95021964) 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 1912620022.
Provider's Profile
| Full Name | Tanagra Jackson |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Location | 30427 Delta Dr, Nuevo, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1912620022
- Provider Enumeration Date: 09/22/2022
- Last Update Date: 08/03/2024
Medicare PECOS Information:
- PECOS PAC ID: 2466818505
- Enrollment ID: I20230516002834
Medical Identifiers
Medical identifiers for Tanagra Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1912620022 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LF0000X | Nurse Practitioner - Family | 95021964 (California) | Secondary |
| 363L00000X | Nurse Practitioner | 95021964 (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. Tanagra Jackson allows following entities to bill medicare on her behalf.
| Entity Name | Hs Clinical Services Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1740444546
PECOS PAC ID: 7810208006
Enrollment ID: O20151020000655 |
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| Entity Name | Evernorth Care Providers - Tennessee Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1164100400
PECOS PAC ID: 7911355532
Enrollment ID: O20231130003226 |
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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. Tanagra 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 |
|---|
Tanagra Jackson, FNP
30427 Delta Dr,
Nuevo, CA 92567-9470
Ph: (773) 530-5217 | Tanagra Jackson, FNP
30427 Delta Dr,
Nuevo, CA 92567-9470
Ph: (773) 530-5217 |
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