TYRA JACKSON FNP-BC
NPI 1154284453
Pain Medicine - Interventional Pain Medicine in Hinsdale, IL
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
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
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.
Medicare Billing Reassignment
Medicare enrollment records show Tyra Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Bolingbrook, IL 60440
- Reassigned Medicare billing, Illinois enrollment
- 10 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, ILAdventist Hinsdale Hospital
Acute Care Hospitals · Hinsdale, ILUchicago Medicine Adventhealth Bolingbrook
Acute Care Hospitals · Bolingbrook, ILPhysician 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.
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.
HINSDALE, IL 60521
HINSDALE, IL 60521
HINSDALE, IL 60521
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.
Which organization bills Medicare for Tyra Jackson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Tyra Jackson reassigns Medicare benefits to Chicagoland Pain Management Institute, Inc. (Bolingbrook, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tyra Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Tyra Jackson accept?
Health plans from Ambetter Health and Ambetter Health of Delaware list Tyra Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
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 10 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.
# Tyra Jackson, FNP-BC · NPI 1154284453
Interventional Pain Medicine physician in Hinsdale, Illinois. Individual provider, active in the CMS NPPES registry since December 4, 2025.
## Identity
- **NPI:** 1154284453 (Entity type: Individual)
- **Enumerated:** December 4, 2025
- **Primary specialty:** Pain Medicine - Interventional Pain Medicine · taxonomy 208VP0014X
- **State license:** 209.033340 (Illinois)
- **Sole proprietor:** No
## Practice location
- **Address:** 120 N OAK ST, Hinsdale, IL 60521-3829
- **Phone:** (630) 856-6825
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Chicagoland Pain Management Institute, Inc. (NPI 1801146303, Bolingbrook, IL), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2025
## Record status
- **NPPES last updated:** December 4, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1154284453) · Data from the CMS NPPES public registry.