BROOKE A JACKSON (PA-C) – Physician Assistant, NPI 1508905662
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Provider Addresses for BROOKE A JACKSON (PA-C)
117 E Clark St
Harrisburg, IL 629462702
Phone: (618) 252-8625
Fax: (618) 252-2540
Type: Location
2808 Outer Dr
Marion, IL 629595207
Phone: (618) 993-3817
Fax: (618) 993-3908
Type: Location
PO BOX 3988
CARBONDALE, IL 629023988
Phone: (618) 457-5200
Type: Mailing
117 E CLARK ST
HARRISBURG, IL 629462702
Phone: (618) 252-8625
Fax: (618) 252-2540
Type: Location
2331 NEW HOLT RD
PADUCAH, KY 420017404
Phone: (704) 411-4777
Fax: (270) 441-4780
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 35 Open Payments records for all available years, with a total value of $590.
Total Amount is formed as General ($590) + Research ($0) + Ownership ($0) = $590.
Last reported payment date: 2024-12-18 • Largest payer in this snapshot: Eisai Inc. ($89).
Total Amount
$590
General + Research + Ownership
Payments
35
Total payment records
General Amount
$590
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Eisai Inc. | $89 |
| Axsome Therapeutics, Inc. | $88 |
| AstraZeneca Pharmaceuticals LP | $85 |
| Novo Nordisk Inc | $63 |
| Lilly USA, LLC | $46 |
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: 2023-08-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20041019000747 | I | Physician Assistant | IL | TBD |
| I20230807001414 | I | Physician Assistant | KY | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 62946)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| H E M A T O L O G Y/ O N C O L O G Y | IL | |
| Cardiovascular Disease (Cardiology) | IL | |
| - | IL | |
| Emergency Medicine | IL | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | IL | |
| Emergency Medicine | IL | |
| - | IL | |
| N E U R O L O G Y | IL | |
| U R O L O G Y | IL |
Reviews
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