GRACIE ELLEN JACKSON PMHNP-BC
NPI 1255956314
Nurse Practitioner - Psychiatric/Mental Health in South Pasadena, CA
About Gracie Ellen Jackson Pmhnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GRACIE ELLEN JACKSON PMHNP-BC (NPI 1255956314) is an individual psychiatric/mental health provider in South Pasadena, California, licensed in California (NP95015149) and active in the NPI registry since June 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2020).
NPPES Registry Identity
Specialties & Licenses
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
Gracie Ellen Jackson Pmhnp-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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 91030 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.
SOUTH PASADENA, CA 91030
S PASADENA, CA 91030
SOUTH PASADENA, CA 91030
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 Gracie Jackson's NPI number?
The NPI number for Gracie Jackson is 1255956314. It was assigned to this individual provider in the NPPES registry on June 14, 2020.
Where is Gracie Jackson located?
Gracie Jackson practices at 625 Fair Oaks Ave Ste 300, South Pasadena, CA 91030. The listed phone number is (626) 441-4221.
What is Gracie Jackson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Gracie Jackson enrolled in Medicare?
Yes. Gracie 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.
When was this NPI record last updated?
The NPPES record for Gracie Jackson was last updated on March 11, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.
# Gracie Ellen Jackson, PMHNP-BC · NPI 1255956314
Psychiatric/Mental Health physician in South Pasadena, California. Individual provider, active in the CMS NPPES registry since June 14, 2020.
## Identity
- **NPI:** 1255956314 (Entity type: Individual)
- **Enumerated:** June 14, 2020
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** NP95015149 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 625 FAIR OAKS AVE STE 300, South Pasadena, CA 91030-5805
- **Phone:** (626) 441-4221
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** March 11, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1255956314) · Data from the CMS NPPES public registry.