Deactivated NPI 1083618904 Deactivated / Inactive NPI Male Practitioner

Dr. Farris Jackson , MD

Specialist • Fenton, MO

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Farris Jackson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date June 09, 2005

NPI Deactivation Date July 30, 2026

Total Practice Duration ~21 Years of Practice (2005 – 2026)

Professional Overview & Biography Verified Profile Summary

Dr. Farris Jackson, MD was a registered Specialist practicing in Fenton, MO. Throughout an active medical career spanning 21 years, Dr. Jackson provided care at the practice location at 1011 BOWLES AVE until profile deactivation on 2026-07-30.

Historical Medicare Part B clinical services included established patient outpatient office visit, determination of lung volumes using plethysmography, test to examine how well the lungs exchange gases. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

1011 Bowles Ave
Suite 300

Fenton, MO 630262395

Telephone 6364965030

Fax 6364965025

Associated Practice Facility / Clinic

🏢 Peter J Anderson, Md Pc Facility NPI 1568433639

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Fenton, MO

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 10.5 Yrs

State Avg: 37.3 Yrs

Regional Practice Density

2 Specialists

Practicing in Fenton, MO (503 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

43.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2023)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	82	66	$213.00	$124.48
99213 Established patient office or other outpatient visit, typically 15 minutes	42	42	$145.00	$87.97
94726 Determination of lung volumes using plethysmography	30	30	$25.00	$11.55
94729 Test to examine how well the lungs exchange gases	29	29	$18.00	$8.58
94060 Test to measure expiratory airflow and volume changes before and after medication administration	26	26	$30.00	$9.90

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	245	135	$213.00	$126.62
94729 Test to examine how well the lungs exchange gases	109	97	$18.00	$8.83
94726 Determination of lung volumes using plethysmography	107	95	$25.00	$11.89
94060 Test to measure expiratory airflow and volume changes before and after medication administration	103	91	$30.00	$10.19
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	81	14	$208.00	$100.02
99213 Established patient office or other outpatient visit, typically 15 minutes	66	59	$145.00	$89.72
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	51	51	$327.00	$162.60
G0400 Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels	24	24	$240.00	$40.73
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	18	17	$406.00	$193.78
94010 Test to measure expiratory airflow and volume	17	16	$71.00	$26.48

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	248	136	$213.00	$127.24
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	221	37	$208.00	$102.05
94060 Test to measure expiratory airflow and volume changes before and after medication administration	87	82	$30.00	$10.27
94729 Test to examine how well the lungs exchange gases	87	82	$18.00	$8.89
94726 Determination of lung volumes using plethysmography	87	82	$25.00	$11.99
99213 Established patient office or other outpatient visit, typically 15 minutes	57	49	$145.00	$91.03
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	39	36	$406.00	$197.86
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	36	36	$327.00	$167.33
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	17	17	$412.00	$209.15
94010 Test to measure expiratory airflow and volume	15	14	$71.00	$29.37
G0400 Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels	13	13	$240.00	$74.84

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	221	129	$213.00	$105.92
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	173	43	$208.00	$103.82
94729 Test to examine how well the lungs exchange gases	72	69	$18.00	$9.26
94726 Determination of lung volumes using plethysmography	70	67	$25.00	$12.48
94060 Test to measure expiratory airflow and volume changes before and after medication administration	69	67	$30.00	$13.18
99213 Established patient office or other outpatient visit, typically 15 minutes	63	52	$145.00	$74.23
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	47	42	$406.00	$198.51
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	27	15	$146.00	$71.93
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	24	24	$327.00	$163.92

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	336	85	$208.00	$103.54
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	302	156	$213.00	$107.18
94729 Test to examine how well the lungs exchange gases	111	107	$18.00	$9.29
94726 Determination of lung volumes using plethysmography	108	104	$25.00	$12.50
94060 Test to measure expiratory airflow and volume changes before and after medication administration	105	102	$30.00	$13.20
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	93	81	$406.00	$201.61
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	56	28	$146.00	$73.15
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	53	53	$327.00	$161.77
94010 Test to measure expiratory airflow and volume	32	27	$71.00	$34.83
99213 Established patient office or other outpatient visit, typically 15 minutes	31	26	$145.00	$73.81
94010 Test to measure expiratory airflow and volume	14	14	$17.00	$8.57

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	354	203	$127.70	$102.06
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	354	114	$161.24	$100.48
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	120	103	$261.00	$195.51
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	113	58	$126.73	$70.16
94640 Inhalation treatment for airway obstruction or sputum production	100	92	$32.00	$17.06
94060 Test to measure expiratory airflow and volume changes before and after medication administration	100	92	$110.00	$56.15
94729 Test to examine how well the lungs exchange gases	96	88	$100.00	$50.02
94060 Test to measure expiratory airflow and volume changes before and after medication administration	95	95	$87.26	$12.39
94726 Determination of lung volumes using plethysmography	91	83	$100.00	$50.60
94729 Test to examine how well the lungs exchange gases	88	88	$74.84	$8.79
94726 Determination of lung volumes using plethysmography	85	85	$76.18	$11.82
99213 Established patient office or other outpatient visit, typically 15 minutes	46	40	$89.43	$69.55
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	32	32	$226.41	$157.69
94010 Test to measure expiratory airflow and volume	24	23	$71.08	$33.91
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	15	15	$165.47	$131.51

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	453	107	$147.00	$102.91
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	396	219	$110.00	$103.85
94060 Test to measure expiratory airflow and volume changes before and after medication administration	167	146	$110.00	$58.29
94640 Inhalation treatment for airway obstruction or sputum production	166	147	$32.00	$17.61
94729 Test to examine how well the lungs exchange gases	159	138	$100.00	$52.06
94726 Determination of lung volumes using plethysmography	151	132	$100.00	$50.46
94060 Test to measure expiratory airflow and volume changes before and after medication administration	132	130	$110.00	$12.83
94729 Test to examine how well the lungs exchange gases	124	123	$100.00	$9.01
94726 Determination of lung volumes using plethysmography	123	122	$100.00	$12.14
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	121	101	$221.00	$200.35
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	85	52	$121.00	$71.31
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	48	48	$168.00	$161.12
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	43	40	$157.00	$139.31
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	28	28	$210.00	$202.71
99213 Established patient office or other outpatient visit, typically 15 minutes	24	24	$74.00	$71.39
95806 Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort	15	15	$200.00	$60.85
94664 Evaluation of use of breathing device	13	13	$32.00	$15.33

Medical Specialties & State Licenses

Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

State License MO R9F09

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners

Jeannette Bender , FNP-C

Nurse Practitioner - Family

NPI 1104478494

Family Nurse Practitioner (Certified)

Dr. Michael Mastromichalis , MD

Urology

NPI 1346444700

Doctor of Medicine (M.D.)

Dr. Courtney Cockerell , DO

Internal Medicine - Gastroenterology

NPI 1346504644

Doctor of Osteopathic Medicine (D.O.)

Dr. Enrique Pastrana , MD

Surgery

NPI 1417940412

Doctor of Medicine (M.D.)

Laura Allen , NP

Nurse Practitioner - Adult Health

NPI 1760878839

Nurse Practitioner

Dr. Suman Vaddi , MD

Internal Medicine - Pulmonary Disease

NPI 1790125318

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

12 Historical Events

⚠️

NPI Profile Deactivated July 30, 2026

Record deactivated on July 30, 2026

✅

NPI Profile Active February 10, 2017

NPI status registered as active in NPPES database

📍

Updated Practice Location February 10, 2017

Registered at 11200 TESSON FERRY RD., STE 100, ST LOUIS, MO 631236922 (Tel: 3148491500)

📍

Updated Business Mailing Address February 10, 2017

Registered at 11200 TESSON FERRY RD., STE 100, ST LOUIS, MO 631236922 (Tel: 3148491500)

👤

Provider Name / Credentials Updated February 10, 2017

Recorded as FARRIS JACKSON, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) February 10, 2017

Specialist (License #R9F09 in MO)

✅

NPI Profile Active August 01, 2011

NPI status registered as active in NPPES database

📍

Updated Practice Location August 01, 2011

Registered at 1011 BOWLES AVE, SUITE 300, FENTON, MO 630262395 (Tel: 6364965030)

📍

Updated Business Mailing Address August 01, 2011

Registered at 1011 BOWLES AVE, SUITE 300, FENTON, MO 630262395 (Tel: 6364965030)

👤

Provider Name / Credentials Updated August 01, 2011

Recorded as FARRIS JACKSON, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 01, 2011

Specialist (License #R9F09 in MO)

🟢

Initial NPI Registration & Enumeration June 09, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1083618904

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: June 09, 2005

Last Update: August 01, 2011

Deactivation Date: July 30, 2026

Update or Correct Profile

Mailing Address

1011 Bowles Ave, Suite 300

Fenton, MO 630262395

Phone: 6364965030

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.