KEITH E JACKSON (CRNA) – Certified Registered Nurse Anesthetist, NPI 1205866142
Certified Registered Nurse Anesthetist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,626 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in AL
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Provider Addresses for KEITH E JACKSON (CRNA)
100, Rice Mine Road North, Rivermont, Tuscaloosa, Tuscaloosa County, Alabama, 35406, United States
TUSCALOOSA, AL 354062300
Phone: (205) 354-0010
Type: Location
712, Robin Road, Sandusky, Birmingham, Jefferson County, Alabama, 35214, United States
BIRMINGHAM, AL 352143524
Phone: (205) 213-8420
Fax: (205) 798-5918
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $25.
Total Amount is formed as General ($25) + Research ($0) + Ownership ($0) = $25.
Last reported payment date: 2024-11-06 • Largest payer in this snapshot: Mentor Worldwide LLC ($25).
Total Amount
$25
General + Research + Ownership
Payments
1
Total payment records
General Amount
$25
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-06
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Mentor Worldwide LLC | $25 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-07-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040707000524 | I | Certified Registered Nurse Anesthetist (Crna) | AL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 00142 | Anesthesia for lens surgery | 14 | 11 | $0 |
Insurance plans in this area (ZIP 35406)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | AL | |
| General Surgery | WI | |
| Certified Registered Nurse Anesthetist (Crna) | AL | |
| Nurse Practitioner | OR | |
| - | AL | |
| Certified Registered Nurse Anesthetist (Crna) | AL | |
| - | AL | |
| Certified Registered Nurse Anesthetist (Crna) | AL | |
| - | AL | |
| Nurse Practitioner | AL |
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