MS. SAMALA JACKSON CRNP
NPI 1184362600
Nurse Practitioner - Gerontology in Berwyn, PA

Q: What is Samala Jackson's NPI number?

The NPI number for Samala Jackson is 1184362600. It was assigned to this individual provider in the NPPES registry on May 24, 2022.

Q: What is Samala Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Q: When was this NPI record last updated?

The NPPES record for Samala Jackson was last updated on October 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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 May 24, 2022PECOS EnrolledAccepts Medicare Assignment

1055 WESTLAKES DR STE 3152, BERWYN, PA 19312(215) 346-6050(215) 220-3562 Get Directions Write a Review

NPPES record last updated: October 24, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Sep 19, 2024, May 24, 2022 (2 updates tracked since 2022).

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About Ms. Samala Jackson Crnp NPPES

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

MS. SAMALA JACKSON CRNP (NPI 1184362600) is an individual gerontology provider in Berwyn, Pennsylvania, licensed in Pennsylvania (SP018935) and active in the NPI registry since May 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1184362600

Entity TypeIndividualFemale

Primary Taxonomy363LG0600X

Provider Legal NameMS. SAMALA JACKSONCredential: CRNP

Location Address1055 WESTLAKES DR STE 3152Berwyn, PA 19312-2410

Mailing AddressPo Box 40412Belfast, ME 04915-1255 · (248) 824-6500 · Fax (855) 618-6655

Phone(215) 346-6050

Fax(215) 220-3562

Sole ProprietorYes

Medical School CMSOtherGraduated 2017

Enumeration DateMay 24, 2022

Last NPPES UpdateOctober 24, 20252 updates tracked since enumeration

NPPES CertifiedOctober 24, 2025

✔ NPI 1184362600 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LG0600X

License✔ Licensed in PA · SP018935

1055 WESTLAKES DR STE 3152, Berwyn, PA 19312

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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 and accepts Medicare assignment

Ms. Samala Jackson Crnp 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 ID6800277153

PECOS Enrollment IDI20220718001252

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.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes 99349

An established patient home visit is a medical appointment conducted at your home, typically lasting around 40 minutes. This service is ideal for patients who may find it difficult to travel to a healthcare facility. During this visit, a healthcare professional will evaluate your health status, manage your care, and answer any health-related questions you may have.

334 services82 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

18 services18 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19312 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

$92.69 typical visit price

range $59.88 – $180.99

Typical copayment $23.17 (range $14.97 – $45.24)

Most-billed visit code 99203

Established Patient

$105.21 typical visit price

range $19.30 – $147.29

Typical copayment $26.30 (range $4.82 – $36.82)

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 7

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

VPA PC

Family Medicine