SAMUEL WESLEY JACKSON MD
NPI 1114480001
Psychiatry & Neurology - Psychiatry in Chicago, IL

Q: What is Samuel Jackson's NPI number?

The NPI number for Samuel Jackson is 1114480001. It was assigned to this individual provider in the NPPES registry on April 9, 2019.

Q: What is Samuel Jackson's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Q: When was this NPI record last updated?

The NPPES record for Samuel Jackson was last updated on November 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months 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.

Active since April 09, 2019PECOS EnrolledAccepts Medicare Assignment

5215 N CALIFORNIA AVE FL 7, CHICAGO, IL 60625(718) 270-8867 Get Directions Write a Review

NPPES record last updated: November 26, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Samuel Wesley Jackson Md NPPES

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

SAMUEL WESLEY JACKSON MD (NPI 1114480001) is an individual psychiatry provider in Chicago, Illinois, licensed in Illinois (169934) and active in the NPI registry since April 2019. He is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1114480001

Entity TypeIndividualMale

Primary Taxonomy2084P0800X

Provider Legal NameSAMUEL WESLEY JACKSONCredential: MD

Location Address5215 N CALIFORNIA AVE FL 7Chicago, IL 60625-7014

Mailing Address5215 N California Ave Fl 7Chicago, IL 60625-7014

Phone(718) 270-8867

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateApril 9, 2019

Last NPPES UpdateNovember 26, 2024

NPPES CertifiedNovember 26, 2024

✔ NPI 1114480001 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

License✔ Licensed in IL · 169934

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

5215 N CALIFORNIA AVE FL 7, Chicago, IL 60625

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Samuel Wesley Jackson Md 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 ID1759821002

PECOS Enrollment IDI20250103002976

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60625 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

$183.39 typical visit price

range $60.08 – $183.39

Typical copayment $45.84 (range $15.02 – $45.84)

Most-billed visit code 99205

Established Patient

$74.80 typical visit price

range $18.97 – $148.12

Typical copayment $18.70 (range $4.74 – $37.03)

Most-billed visit code 99213

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 19

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

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