WARREN ORLANDO JACKSON (AGNP) – Gerontology Nurse Practitioner, NPI 1548718448
Gerontology Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
7,017 NURSE PRACTITIONER in MO
Provider Addresses for WARREN ORLANDO JACKSON (AGNP)
12101, Woodcrest Executive Drive, Creve Coeur, Saint Louis County, Missouri, 63141, United States
SUITE 210
SAINT LOUIS, MO 631415047
Phone: (314) 317-0600
Fax: (314) 317-0606
Type: Mailing
12303 DE PAUL DR
BRIDGETON, MO 630442512
Phone: (314) 317-0600
Fax: (314) 317-0606
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2016-10-18
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 |
|---|---|---|---|---|
| I20161018002774 | I | Nurse Practitioner | MO | 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 |
|---|---|---|---|---|
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 139 | 134 | $0 |
| 99497 | Advance care planning, first 30 minutes | 123 | 121 | $0 |
Insurance plans in this area (ZIP 63141)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Hospitalist, Internal Medicine | IL | |
| Internal Medicine | MO | |
| H O S P I T A L I S T | MS | |
| Internal Medicine | CA | |
| H O S P I T A L I S T | SC | |
| Hospitalist, Internal Medicine | CA | |
| - | MO | |
| Internal Medicine | CA | |
| - | OR | |
| Internal Medicine, Hospitalist | IL |
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