MICHELLE LYNN JACKSON APRN
NPI 1790347722
Nurse Practitioner - Family in Peoria, IL

Q: What is Michelle Jackson's NPI number?

The NPI number for Michelle Jackson is 1790347722. It was assigned to this individual provider in the NPPES registry on June 29, 2019.

Q: What is Michelle Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Michelle Jackson was last updated on December 14, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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 June 29, 2019PECOS EnrolledAccepts Medicare Assignment

8914 N KNOXVILLE AVE, PEORIA, IL 61615(309) 691-9110 Get Directions Write a Review

NPPES record last updated: December 14, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Michelle Lynn Jackson Aprn NPPES

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

MICHELLE LYNN JACKSON APRN (NPI 1790347722) is an individual family provider in Peoria, Illinois, licensed in Illinois (209019281) and active in the NPI registry since June 2019. She is enrolled in Medicare PECOS, is affiliated with St Mary Medical Center, and is a graduate of Other (2018).

NPPES Registry Identity

NPI1790347722

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameMICHELLE LYNN JACKSONCredential: APRN

Location Address8914 N KNOXVILLE AVEPeoria, IL 61615-1410

Mailing Address8914 N Knoxville AvePeoria, IL 61615-1410 · (309) 691-9110

Phone(309) 691-9110

Sole ProprietorYes

Medical School CMSOtherGraduated 2018

Enumeration DateJune 29, 2019

Last NPPES UpdateDecember 14, 2024

NPPES CertifiedDecember 14, 2024

✔ NPI 1790347722 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in IL · 209019281

Also ListedFamily MedicineTaxonomy 207Q00000X · License 209.019281 (IL)

8914 N KNOXVILLE AVE, Peoria, IL 61615

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware, Wellmark Health Plan of Iowa, Inc..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

Michelle Lynn Jackson Aprn 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 ID749612554

PECOS Enrollment IDI20191118000138

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.

Medicare Billing Reassignments

Medicare enrollment records show Michelle Jackson reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Proctor Health Systems

3.0 mi

Ambulatory Surgical

5401 N KNOXVILLE AVE, STE 217
Peoria, IL 61614

Reassigned Medicare billing, Illinois enrollment
349 clinicians in this Medicare group

NPI 1720223837 (309) 691-1092

Methodist Medical Center Of Illinois

6.6 mi

Psychiatric Unit

221 NE GLEN OAK AVE
Peoria, IL 61636

Reassigned Medicare billing, Illinois enrollment
Also billed through NPI 1164474755 (Illinois)
693 clinicians in this Medicare group

NPI 1275583155 (309) 672-5522

Hammond Henry Dist Hospital

20 mi

Rural Health

101 S GALENA AVE
Wyoming, IL 61491

Reassigned Medicare billing, Illinois enrollment
Also billed through NPI 1457344491 (Illinois)
33 clinicians in this Medicare group

NPI 1437698123 (309) 853-3677

Carle Health Medical Group

87 mi

Internal Medicine

611 W PARK ST
Urbana, IL 61801

Reassigned Medicare billing, Illinois enrollment
Medicare enrollment name: Carle Health Care Incorporated
2,516 clinicians in this Medicare group

NPI 1154653947 (217) 383-8300

Iowa Physicians Clinic Medical Foundation

225 mi

General Practice

1776 W LAKES PKWY STE 400
West Des Moines, IA 50266

Reassigned Medicare billing, Illinois enrollment
178 clinicians in this Medicare group

NPI 1366425274 (515) 471-9300

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 4

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

St Mary Medical Center

Acute Care Hospitals · Galesburg, IL

3/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number140064

Location3333 North SeminaryGalesburg, IL 61401 · Knox County

Emergency services Birthing friendly

Saint Francis Medical Center

Acute Care Hospitals · Peoria, IL

1/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140067

Location530 NE Glen Oak AvePeoria, IL 61637 · Peoria County

Emergency services Birthing friendly

Hammond Henry Hospital

Critical Access Hospitals · Geneseo, IL

OwnershipGovernment - Hospital District or Authority

CMS Certification Number141319

Location600 N College AvenueGeneseo, IL 61254 · Henry County

Emergency services

Osf Saint Luke Medical Center

Critical Access Hospitals · Kewanee, IL

OwnershipVoluntary non-profit - Private

CMS Certification Number141325

Location1051 West South StreetKewanee, IL 61443 · Henry County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61615 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

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$97.25 typical visit price

range $17.16 – $136.56

Typical copayment $24.31 (range $4.29 – $34.14)

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.

Referred Medical Equipment & Supplies CMS DME claims 5

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

5 suppliers18 claims48 services$6.37 avg. paid by Medicare

Face mask interface, replacement for full face mask, each A7031

DME-Other DME · category DE001N

3 suppliers11 claims21 services$32.22 avg. paid by Medicare

Filter, disposable, used with positive airway pressure device A7038

DME-Other DME · category DE001N

3 suppliers18 claims73 services$2.15 avg. paid by Medicare

Humidifier, heated, used with positive airway pressure device E0562

DME-Other DME · category DE001N

1 supplier11 claims11 services$12.95 avg. paid by Medicare

Continuous positive airway pressure (cpap) device E0601

DME-Other DME · category DE001N

2 suppliers27 claims27 services$40.94 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 13

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

JULIE WAGNER

Nurse Practitioner (Family)