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TYRA JACKSON FNP-BC
NPI 1154284453
Pain Medicine - Interventional Pain Medicine in Hinsdale, IL

Active since December 04, 2025PECOS EnrolledAccepts Medicare Assignment
120 N OAK ST, HINSDALE, IL 60521(630) 856-6825 Get Directions Write a Review

NPPES record last updated: December 4, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Tyra Jackson Fnp-bc NPPES

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

TYRA JACKSON FNP-BC (NPI 1154284453) is an individual interventional pain medicine provider in Hinsdale, Illinois, licensed in Illinois (209.033340) and active in the NPI registry since December 2025. She is enrolled in Medicare PECOS, is affiliated with Adventist La Grange Memorial Hospital, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1154284453
Entity TypeIndividualFemale
Primary Taxonomy208VP0014X
Provider Legal NameTYRA JACKSONCredential: FNP-BC
Location Address120 N OAK STHinsdale, IL 60521-3829
Mailing Address420 S. Schmidt Rd, Suite 110Bolingbrook, IL 60440 · (630) 312-4505
Phone(630) 856-6825
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateDecember 4, 2025
NPPES CertifiedDecember 4, 2025
✔ NPI 1154284453 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPain Medicine · Interventional Pain MedicineAllopathic & Osteopathic Physicians
Taxonomy Code208VP0014X
License✔ Licensed in IL · 209.033340
Definition
Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment.
120 N OAK ST, Hinsdale, IL 60521
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tyra Jackson Fnp-bc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6406334002
PECOS Enrollment IDI20260203003239
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.

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Adventist La Grange Memorial Hospital

Acute Care Hospitals · La Grange, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number140065
Location5101 S Willow Springs RdLa Grange, IL 60525 · Cook County
Emergency services

Adventist Hinsdale Hospital

Acute Care Hospitals · Hinsdale, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140122
Location120 North Oak StHinsdale, IL 60521 · Du Page County
Emergency services Birthing friendly

Uchicago Medicine Adventhealth Bolingbrook

Acute Care Hospitals · Bolingbrook, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140304
Location500 Remington BoulevardBolingbrook, IL 60440 · Will County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60521 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
$137.43 typical visit price
range $59.81 – $181.38
Typical copayment $34.35 (range $14.95 – $45.34)
Most-billed visit code 99204
Established Patient
$105.07 typical visit price
range $19.15 – $147.12
Typical copayment $26.26 (range $4.78 – $36.78)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

DU PAGE PATHOLOGY ASSOCIATES SC
Pathology (Anatomic Pathology & Clinical Pathology)
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-9000
KEITH KEY LEE DO
Anesthesiology (Pediatric Anesthesiology)
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-9000
ROLAND E. LONSER M.D.
Pathology (Anatomic Pathology & Clinical Pathology)
120 N OAK ST, HINSDALE HOSPITAL / PATHOLOGY DEP
HINSDALE, IL 60521
Dupage County (630) 856-7850
CARLOS O. MARTINEZ MD
Emergency Medicine
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-6782
AGNIESZKA U. PIOTROWSKI M.D.
Pathology (Anatomic Pathology & Clinical Pathology)
120 N OAK ST, HINSALE HOSPITAL / PATHOLOGY DEPAR
HINSDALE, IL 60521
Dupage County (630) 856-8750
DAVID BERGQUIST M.D
Anesthesiology
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-9000
YEHUDA LEOR BROMBERG NP
Nurse Practitioner
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-6700
DANIEL WATTS CRNA
Nurse Anesthetist, Certified Registered
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-9000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tyra Jackson's NPI number?

The NPI number for Tyra Jackson is 1154284453. It was assigned to this individual provider in the NPPES registry on December 4, 2025.

Where is Tyra Jackson located?

Tyra Jackson practices at 120 N Oak St, Hinsdale, IL 60521. The listed phone number is (630) 856-6825.

What is Tyra Jackson's specialty?

The primary specialty registered for this NPI is Pain Medicine, specializing in Interventional Pain Medicine, with taxonomy code 208VP0014X.

Is Tyra Jackson enrolled in Medicare?

Yes. Tyra Jackson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Tyra Jackson affiliated with any hospitals?

According to CMS data, Tyra Jackson is affiliated with Adventist La Grange Memorial Hospital, Adventist Hinsdale Hospital and Uchicago Medicine Adventhealth Bolingbrook.

When was this NPI record last updated?

The NPPES record for Tyra Jackson was last updated on December 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.