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

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: November 01, 2026.

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

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, maintains 2 additional practice locations, 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
Open in Google Maps ↗

Secondary Practice Locations 2

Location 13621 Aramingo Ave Ste 5CPhiladelphia, PA 19134-4607 · Phone (215) 444-7472 · Fax (215) 979-6726
Location 29200 Bustleton Ave Apt 1705Philadelphia, PA 19115-4230 · Phone (215) 760-6386

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter Health of Delaware.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

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.

Medicare Billing Reassignments

3

Medicare enrollment records show Samala Jackson reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Vpa PC
Same address
Family Medicine
1055 WESTLAKES DR STE 3152
Berwyn, PA 19312
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 38 clinicians in this Medicare group
NPI 1922611532 (248) 434-6169
Primary Homecare, LLC
18 mi
Primary Care
8118 OLD YORK RD, SUITE D
Elkins Park, PA 19027
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 28 clinicians in this Medicare group
NPI 1629023593 (215) 635-3151
Osh - PA Physicians Group, PC
20 mi
Primary Care
3621 ARAMINGO AVE STE C5
Philadelphia, PA 19134
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 196 clinicians in this Medicare group
NPI 1811405533 (215) 444-7472

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Chester County (248) 434-6169
LAURA ANN VANDENBERG
Nurse Practitioner (Family)
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Chester County (212) 346-6050
KHRYSTYNA KOBYLYNETS NP
Nurse Practitioner
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Chester County (215) 346-6050
VPA PC
Radiology (Diagnostic Radiology)
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Chester County (215) 346-6050
VPA PC
Family Medicine
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Chester County (248) 434-6169
JOHN DOUGLAS LAWSON DO
Family Medicine
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Chester County (215) 346-6050
LAUREN KIN CRNP
Nurse Practitioner
1055 WESTLAKES DR STE 3152
BERWYN, PA 19312
Chester County (215) 346-6050

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 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.

Where is Samala Jackson located?

Samala Jackson practices at 1055 Westlakes Dr Ste 3152, Berwyn, PA 19312. The listed phone number is (215) 346-6050.

What is Samala Jackson's specialty?

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

Is Samala Jackson enrolled in Medicare?

Yes. Samala Jackson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Samala Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samala Jackson reassigns Medicare benefits to 3 organizations: Vpa PC (Berwyn, PA), Primary Homecare, LLC (Elkins Park, PA) and Osh - PA Physicians Group, PC (Philadelphia, PA). 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 Samala Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Samala Jackson accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Buckeye Health Plan list Samala 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 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 12 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.