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KIM ELAINE JACKSON LICSW
NPI 1184275166
Social Worker - Clinical in Oakland, CA

Active since September 22, 2019PECOS Enrolled
4909 DAVENPORT AVE, OAKLAND, CA 94619(206) 549-4668(206) 568-7043 Get Directions Write a Review

NPPES record last updated: April 3, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 3, 2024, Sep 22, 2019 (2 updates tracked since 2019).

About Kim Elaine Jackson Licsw NPPES

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

KIM ELAINE JACKSON LICSW (NPI 1184275166) is an individual clinical provider in Oakland, California, licensed in Washington (LW61326871) and active in the NPI registry since September 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1184275166
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameKIM ELAINE JACKSONCredential: LICSW
Location Address4909 DAVENPORT AVEOakland, CA 94619-2920
Mailing Address1253 C St SeWashington, DC 20003-2202 · (206) 549-4668 · Fax (206) 568-7043
Phone(206) 549-4668
Fax(206) 568-7043
Sole ProprietorNo
Enumeration DateSeptember 22, 2019
Last NPPES UpdateApril 3, 20242 updates tracked since enumeration
NPPES CertifiedApril 3, 2024
✔ NPI 1184275166 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Licenses✔ Licensed in WA · LW61326871✔ Licensed in DC · LC50082406
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
4909 DAVENPORT AVE, Oakland, CA 94619
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Other Names 1

Professional Name (2)Ms. Kim Elaine Jackson Licsw

Other Identifiers 2

Medicaid2229463DC
Medicaid2229463WA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Harvard Pilgrim Health Care, Moda Health Plan, Inc..Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kim Elaine Jackson Licsw 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.

Medicare Billing Reassignments

2

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

Uplift Health Technologies, Inc.
2,425 mi
Adult Mental Health
3033 WILSON BLVD STE 700
Arlington, VA 22201
  • Reassigned Medicare billing, District of Columbia enrollment
  • 26 clinicians in this Medicare group
NPI 1770189243 (888) 380-2028
Grow Healthcare Group PA
2,582 mi
Mental Health
66 W FLAGLER ST STE 900
Miami, FL 33130
  • Reassigned Medicare billing, District of Columbia and Washington enrollments
  • 1,424 clinicians in this Medicare group
NPI 1245845932 (786) 244-7711

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 94619 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
$0.00 typical visit price
range $69.00 – $202.35
Typical copayment $0.00 (range $17.25 – $50.58)
Most-billed visit code NA
Established Patient
$84.91 typical visit price
range $23.44 – $166.46
Typical copayment $21.22 (range $5.86 – $41.61)
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.

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 Kim Jackson's NPI number?

The NPI number for Kim Jackson is 1184275166. It was assigned to this individual provider in the NPPES registry on September 22, 2019. The provider is also known as Ms. Kim Elaine Jackson Licsw.

Where is Kim Jackson located?

Kim Jackson practices at 4909 Davenport Ave, Oakland, CA 94619. The listed phone number is (206) 549-4668.

What is Kim Jackson's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Kim Jackson enrolled in Medicare?

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

Which organizations bill Medicare for Kim Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kim Jackson reassigns Medicare benefits to 2 organizations: Uplift Health Technologies, Inc. (Arlington, VA) and Grow Healthcare Group PA (Miami, FL). 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 Kim Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kim Jackson accept?

Health plans from Harvard Pilgrim Health Care and Moda Health Plan, Inc. list Kim Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kim Jackson was last updated on April 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.