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DR. JACQUELINE SHALL-MCCUMISKEY PSY. D.
NPI 1083160170
Psychologist - Clinical in Marlton, NJ

Active since August 29, 2016PECOS EnrolledAccepts Medicare Assignment
525 ROUTE 73 N STE 104, MARLTON, NJ 08053(646) 479-8068 Get Directions Write a Review

NPPES record last updated: September 29, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 29, 2022, May 5, 2022, Aug 29, 2016 (3 updates tracked since 2016).

About Dr. Jacqueline Shall-mccumiskey Psy. D. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACQUELINE SHALL-MCCUMISKEY PSY. D. (NPI 1083160170) is an individual clinical provider in Marlton, New Jersey, licensed in New York (021797) and active in the NPI registry since August 2016. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2015).

NPPES Registry Identity

NPI1083160170
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameDR. JACQUELINE SHALL-MCCUMISKEYCredential: PSY. D.
Location Address525 ROUTE 73 N STE 104Marlton, NJ 08053-3422
Mailing Address1675 Richmond RdStaten Island, NY 10304-2317 · (646) 479-8068
Phone(646) 479-8068
Sole ProprietorNo
Medical School CMSOtherGraduated 2015
Enumeration DateAugust 29, 2016
Last NPPES UpdateSeptember 29, 20223 updates tracked since enumeration
NPPES CertifiedSeptember 29, 2022
✔ NPI 1083160170 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in NY · 021797
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
525 ROUTE 73 N STE 104, Marlton, NJ 08053
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Secondary Practice Locations 2

Location 11110 South Ave, Suite 5Staten Island, NY 10314-3403 · Phone (347) 273-1290
Location 21675 Richmond RdStaten Island, NY 10304-2317 · Phone (646) 479-8068

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Jacqueline Shall-mccumiskey Psy. D. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5597043141
PECOS Enrollment IDI20230207000025
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Jacqueline Shall-mccumiskey reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Go Mindful Practice, LLC
Same address
Cognitive & Behavioral
525 ROUTE 73 N STE 104
Marlton, NJ 08053
  • Reassigned Medicare billing, New Jersey enrollment
NPI 1508580937 (646) 479-8068
Cognitive Therapy If Si Pysch Svcs & Lic Mental Health Counselor PLLC
64 mi
Psychologist
1110 SOUTH AVE, SUITE # 5
Staten Island, NY 10314
  • Reassigned Medicare billing, New York enrollment
  • 4 clinicians in this Medicare group
NPI 1437451689 (347) 273-1290

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 08053 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$185.05 typical visit price
range $61.59 – $185.05
Typical copayment $46.26 (range $15.39 – $46.26)
Most-billed visit code 99205
Established Patient
$107.94 typical visit price
range $20.08 – $150.98
Typical copayment $26.98 (range $5.02 – $37.74)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CARA SETTIPANI PH.D.
Psychologist (Clinical Child & Adolescent)
525 ROUTE 73 N STE 104
MARLTON, NJ 08053
Burlington County (201) 579-0140
COMPASSIONATE CARE IN CHRIST LLC
In Home Supportive Care
525 ROUTE 73 N STE 104
MARLTON, NJ 08053
Burlington County (856) 433-7222
CSA ASC LLC
Midwife
525 ROUTE 73 N STE 104
MARLTON, NJ 08053
Burlington County (267) 266-3649
LOTUS SERVICES
In Home Supportive Care
525 ROUTE 73 N STE 104
MARLTON, NJ 08053
Burlington County (732) 803-7422
ADVANCED TREATMENT SOLUTIONS LLC
Community/Behavioral Health
525 ROUTE 73 N STE 104
MARLTON, NJ 08053
Burlington County (856) 588-2342
KYLE MORAGNE
Counselor (Mental Health)
525 ROUTE 73 N STE 104
MARLTON, NJ 08053
Burlington County (856) 565-3236
MONTERA HEALTH NEW JERSEY LLC
Behavior Analyst
525 ROUTE 73 N STE 104
MARLTON, NJ 08053
Burlington County (707) 315-6152
PRIMENEUROPHYSIOLOGY LLC
Specialist/Technologist, Other (Electroneurodiagnostic)
525 ROUTE 73 N STE 104
MARLTON, NJ 08053
Burlington County (908) 590-1917

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacqueline Shall-mccumiskey's NPI number?

The NPI number for Jacqueline Shall-mccumiskey is 1083160170. It was assigned to this individual provider in the NPPES registry on August 29, 2016.

Where is Jacqueline Shall-mccumiskey located?

Jacqueline Shall-mccumiskey practices at 525 Route 73 N Ste 104, Marlton, NJ 08053. The listed phone number is (646) 479-8068.

What is Jacqueline Shall-mccumiskey's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Jacqueline Shall-mccumiskey enrolled in Medicare?

Yes. Jacqueline Shall-mccumiskey is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Jacqueline Shall-mccumiskey's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacqueline Shall-mccumiskey reassigns Medicare benefits to 2 organizations: Go Mindful Practice, LLC (Marlton, NJ) and Cognitive Therapy If Si Pysch Svcs & Lic Mental Health Counselor PLLC (Staten Island, NY). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacqueline Shall-mccumiskey's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jacqueline Shall-mccumiskey was last updated on September 29, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.