DR. JACKS X GILLES PSY.D., LP
NPI 1124212972
Psychologist - Clinical in Louisville, KY

Q: What is Jacks Gilles's NPI number?

The NPI number for Jacks Gilles is 1124212972. It was assigned to this individual provider in the NPPES registry on September 4, 2007.

Q: What is Jacks Gilles's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jacks Gilles was last updated on November 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 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 September 04, 2007PECOS EnrolledAccepts Medicare Assignment

633 BAXTER AVE, LOUISVILLE, KY 40204(502) 309-2408 Get Directions Write a Review

NPPES record last updated: November 19, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 19, 2024, Sep 30, 2024, Oct 21, 2016 and 2 more (5 updates tracked since 2016).

On this page

About Dr. Jacks X Gilles Psy.d., Lp NPPES

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

DR. JACKS X GILLES PSY.D., LP (NPI 1124212972) is an individual clinical provider in Louisville, Kentucky, licensed in Kentucky (129842) and active in the NPI registry since September 2007. The provider is enrolled in Medicare PECOS, maintains a secondary practice location in Louisville, and is a graduate of Other (2011).

NPPES Registry Identity

NPI1124212972

Entity TypeIndividual

Primary Taxonomy103TC0700X

Provider Legal NameDR. JACKS X GILLESCredential: PSY.D., LP

Location Address633 BAXTER AVELouisville, KY 40204-1157

Mailing Address633 Baxter AveLouisville, KY 40204-1157 · (502) 309-2403

Phone(502) 309-2408

Sole ProprietorNo

Medical School CMSOtherGraduated 2011

Enumeration DateSeptember 4, 2007

Last NPPES UpdateNovember 19, 20245 updates tracked since enumeration

NPPES CertifiedNovember 19, 2024

✔ NPI 1124212972 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Licenses✔ Licensed in KY · 129842✔ Licensed in KY · 1745✔ Licensed in KY · 2012-12

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.

633 BAXTER AVE, Louisville, KY 40204

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Secondary Practice Location 1

Location 11190 E BroadwayLouisville, KY 40204-1712 · Phone (502) 627-0905

Other Identifiers 2

Medicaid7100481420KY

Other129842KY · License

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

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. Jacks X Gilles Psy.d., Lp 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 ID9133492580

PECOS Enrollment IDI20170913002014

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 Reassignment

Medicare enrollment records show Jacks Gilles reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mandala House, LLC

Same address

Clinical

633 BAXTER AVE
Louisville, KY 40204

Reassigned Medicare billing, Kentucky enrollment
17 clinicians in this Medicare group

NPI 1659829760 (502) 309-2408

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 40204 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

$162.27 typical visit price

range $52.76 – $162.27

Typical copayment $40.56 (range $13.19 – $40.56)

Most-billed visit code 99205

Established Patient

$93.94 typical visit price

range $16.53 – $131.99

Typical copayment $23.48 (range $4.13 – $32.99)

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 13

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

MRS. GABRIELLE TURNER ELZY

Psychologist (Counseling)