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SAMANTHA L JACKSON
NPI 1174906549
Counselor - Mental Health in Emeryville, CA

Active since July 03, 2015PECOS Enrolled
1335 STANFORD AVE, EMERYVILLE, CA 94608(510) 647-5101 Get Directions Write a Review

NPPES record last updated: April 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Samantha L Jackson NPPES

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

SAMANTHA L JACKSON (NPI 1174906549) is an individual mental health provider in Emeryville, California and active in the NPI registry since July 2015. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174906549
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameSAMANTHA L JACKSON
Location Address1335 STANFORD AVEEmeryville, CA 94608-2536
Mailing Address1335 Stanford AveEmeryville, CA 94608-2536 · (510) 647-5101
Phone(510) 647-5101
Sole ProprietorNo
Enumeration DateJuly 3, 2015
Last NPPES UpdateApril 11, 2025
NPPES CertifiedApril 11, 2025
✔ NPI 1174906549 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
1335 STANFORD AVE, Emeryville, CA 94608
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samantha L Jackson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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.

NAZIR NOOR MD
Pain Medicine (Interventional Pain Medicine)
1335 STANFORD AVE
EMERYVILLE, CA 94608
Alameda County (510) 647-5101
ANGELA LUU PA
Physician Assistant
1335 STANFORD AVE
EMERYVILLE, CA 94608
Alameda County (510) 647-5101
LYUDMILA KUZNETSOVA
Psychologist (Clinical)
1335 STANFORD AVE
EMERYVILLE, CA 94608
Alameda County (415) 806-8179
MR. NEIL KAMLESH KAMDAR M.D.
Anesthesiology (Pain Medicine)
1335 STANFORD AVE
EMERYVILLE, CA 94608
Alameda County (510) 647-5101
MS. ANN CLAIRE MCWALTERS LCSW #19909
Counselor (Mental Health)
1335 STANFORD AVE
EMERYVILLE, CA 94608
Alameda County (510) 647-5101
MARK PHILLIPS
Physician Assistant
1335 STANFORD AVE
EMERYVILLE, CA 94608
Alameda County (510) 647-5101
MS. CARRIE CHRISTINE VOYCE FNP-C
Nurse Practitioner (Family)
1335 STANFORD AVE
EMERYVILLE, CA 94608
Alameda County (510) 647-5101
JENNIFER LYNN VAN BUSKIRK PA-C
Physician Assistant
1335 STANFORD AVE
EMERYVILLE, CA 94608
Alameda County (510) 647-5101

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 Samantha Jackson's NPI number?

The NPI number for Samantha Jackson is 1174906549. It was assigned to this individual provider in the NPPES registry on July 3, 2015.

Where is Samantha Jackson located?

Samantha Jackson practices at 1335 Stanford Ave, Emeryville, CA 94608. The listed phone number is (510) 647-5101.

What is Samantha Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Samantha Jackson enrolled in Medicare?

Yes. Samantha Jackson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Samantha Jackson was last updated on April 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.