TRAVIS WILEY JACKSON MD
NPI 1093657439
Dermatology in Saint Louis, MO

Q: What is Travis Jackson's NPI number?

The NPI number for Travis Jackson is 1093657439. It was assigned to this individual provider in the NPPES registry on April 6, 2026.

Q: What is Travis Jackson's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Q: When was this NPI record last updated?

The NPPES record for Travis Jackson was last updated on May 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 06, 2026PECOS Enrolled

621 S NEW BALLAS RD STE 3019B, SAINT LOUIS, MO 63141(314) 509-5305(314) 251-4454 Get Directions Write a Review

NPPES record last updated: May 27, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 27, 2026, Apr 6, 2026 (2 updates tracked since 2026).

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About Travis Wiley Jackson Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRAVIS WILEY JACKSON MD (NPI 1093657439) is an individual dermatology provider in Saint Louis, Missouri, licensed in Missouri (2026021643) and active in the NPI registry since April 2026. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1093657439

Entity TypeIndividualMale

Primary Taxonomy207N00000X

Provider Legal NameTRAVIS WILEY JACKSONCredential: MD

Location Address621 S NEW BALLAS RD STE 3019BSaint Louis, MO 63141-8267

Mailing Address621 S New Ballas Rd Ste 3019bSaint Louis, MO 63141-8267 · (314) 509-5305 · Fax (314) 251-4454

Phone(314) 509-5305

Fax(314) 251-4454

Sole ProprietorYes

Enumeration DateApril 6, 2026

Last NPPES UpdateMay 27, 20262 updates tracked since enumeration

NPPES CertifiedMay 27, 2026

✔ NPI 1093657439 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

License✔ Licensed in MO · 2026021643

Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

621 S NEW BALLAS RD STE 3019B, Saint Louis, MO 63141

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Travis Wiley Jackson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63141 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$86.32 typical visit price

range $55.65 – $169.38

Typical copayment $21.58 (range $13.91 – $42.34)

Most-billed visit code 99203

Established Patient

$69.50 typical visit price

range $17.76 – $137.92

Typical copayment $17.37 (range $4.44 – $34.48)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CHRISTOPHER SAMAAN MD

Internal Medicine