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

NPI Status: Active since May 24, 2022

Contact Information

1055 WESTLAKES DR STE 3152
BERWYN, PA
ZIP 19312
Phone: (215) 346-6050
Fax: (215) 220-3562

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  • Individual
  • Female
  • Nurse Practitioner
  • Gerontology
  • PECOS Enrolled

About SAMALA JACKSON

This page provides the complete NPI Profile along with additional information for Samala Jackson, a provider established in Berwyn, Pennsylvania with a medical specialization in Nurse Practitioner, focusing in gerontology . The healthcare provider is registered in the NPI registry with number 1184362600 assigned on May 2022. The practitioner's primary taxonomy code is 363LG0600X with license number SP018935 (PA). The provider is registered as an individual and her NPI record was last updated one year ago.

NPI
1184362600
Provider Name
MS. SAMALA JACKSON CRNP
Gender
Female
Entity Type
Individual
Location Address
1055 WESTLAKES DR STE 3152 BERWYN, PA 19312
Location Phone
(215) 346-6050
Location Fax
(215) 220-3562
Mailing Address
PO BOX 40412 BELFAST, ME 04915
Mailing Phone
(248) 824-6500
Mailing Fax
(215) 220-3562
Is Sole Proprietor?
Yes
Enumeration Date
05-24-2022
Last Update Date
10-24-2025
Code Navigator

A nurse practitioner (NP) like Samala Jackson is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

Location Map

Secondary Locations

  • 3621 Aramingo Ave Ste 5C
    Philadelphia, PA 19134
    (215) 444-7472
  • 9200 Bustleton Ave Apt 1705
    Philadelphia, PA 19115
    (215) 760-6386

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Nurse Practitioner Gerontology

Taxonomy Code
363LG0600X
Type
Physician Assistants & Advanced Practice Nursing Providers
License No.
SP018935
License State
PA

Medicare Participation & PECOS Enrollment Status

Samala Jackson is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Administration of influenza virus vaccine

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.

This service was performed 19 times for 19 patients

Established patient home visit, typically 40 minutes

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.

This service was performed 123 times for 67 patients

Influenza vaccine, quadrivalent derived from cell cultures

The quadrivalent influenza vaccine, derived from cell cultures, is a flu shot that protects against four different flu viruses. It's made in labs using cell cultures instead of eggs, making it a good option for those with egg allergies. It's a crucial tool in preventing the flu.

This service was performed 19 times for 19 patients

Physician Visit Costs

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 19312 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $92.69
  • Minimum New Patient Price $59.88
  • Maximum New Patient Price $180.99
  • Average New Patient Copayment $23.17
  • Minimum New Patient Copayment $14.97
  • Maximum New Patient Copayment $45.24

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $105.21
  • Minimum Established Patient Price $19.3
  • Maximum Established Patient Price $147.29
  • Average Established Patient Copayment $26.3
  • Minimum Established Patient Copayment $4.82
  • Maximum Established Patient Copayment $36.82

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1184362600, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 60. The final step is to find the difference between that total and the next multiple of ten (60 - 60 = 0).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
1
Unchanged
Pos 3
8
Doubled → 16 → 1 + 6
Pos 4
4
Unchanged
Pos 5
3
Doubled → 6
Pos 6
6
Unchanged
Pos 7
2
Doubled → 4
Pos 8
6
Unchanged
Pos 9
0
Doubled → 0
Check
0
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 8 → 16 → 7 3 → 6 2 → 4 0 → 0

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 1 + 1 + 6 + 4 + 6 + 6 + 4 + 6 + 0 + 24 = 60

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 60 is 60. The difference is the calculated check digit.

60 - 60 = 0
This NPI is valid
The calculated check digit is 0, which matches the last digit of 1184362600.

Other Providers at the Same Location


The following 10 providers are registered at the same or a nearby location.

Family Medicine (Adult Medicine)
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Family Medicine
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Family Medicine
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Radiology (Diagnostic Radiology)
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Family Medicine
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Nurse Practitioner
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Nurse Practitioner
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Nurse Practitioner (Family)
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Family Medicine
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Family Medicine
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1184362600, enumerated as an "individual" on May 24, 2022.

The provider is located at 1055 WESTLAKES DR STE 3152 BERWYN, PA 19312 and the phone number is (215) 346-6050.

Nurse Practitioner with taxonomy code 363LG0600X and a focus in Gerontology.