GLORIA L JACKSON (CRNP) – Nurse Practitioner, NPI 1013035294
Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
11,469 NURSE PRACTITIONER in PA
Provider Addresses for GLORIA L JACKSON (CRNP)
3400 Civic Center Blvd
PCAM 4 West
Philadelphia, PA 19104
Phone: (215) 615-5858
Fax: (215) 349-8144
Type: Location
900 MEDICAL CENTER DR STE 200
SEWELL, NJ 080802358
Phone: (856) 557-7900
Type: Location
3400 CIVIC CENTER BLVD
PCAM 4 WEST
PHILADELPHIA, PA 19104
Phone: (215) 615-5858
Fax: (215) 349-8144
Type: Mailing
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: 2007-04-17
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 |
|---|---|---|---|---|
| I20070417000364 | I | Nurse Practitioner | PA | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 174 | 114 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 74 | 59 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 44 | 41 | $0 |
Insurance plans in this area (ZIP 19104)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| E N D O C R I N O L O G Y | PA | |
| - | PA | |
| Internal Medicine | PA | |
| N E U R O L O G Y | PA | |
| - | PA | |
| - | PA | |
| Diagnostic Radiology | PA | |
| - | PA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | PA | |
| Sleep Medicine, Internal Medicine | PA |
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