DR. ANGELA DECARLA JACKSON PH.D., LCPC, LMHC
NPI 1194267476
Counselor - Professional in South Bend, IN

NPI Status: Active since November 17, 2016

Contact Information

1251 N EDDY ST STE 200
SOUTH BEND, IN
ZIP 46617
Phone: (312) 798-9755

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  • Individual
  • Female
  • Years of Experience 22
  • Counselor
  • Professional
  • Accepts Insurance
  • May Accept Medicare Approved Payment
  • PECOS Enrolled

About ANGELA JACKSON

This page provides the complete NPI Profile along with additional information for Angela Jackson, a provider established in South Bend, Indiana with a medical specialization in Counselor, focusing in professional and more than 22 years of experience. The healthcare provider is registered in the NPI registry with number 1194267476 assigned on November 2016. The practitioner's primary taxonomy code is 101YP2500X with license number 39004648A (IN). The provider is registered as an individual and her NPI record was last updated one year ago.

NPI
1194267476
Provider Name
DR. ANGELA DECARLA JACKSON PH.D., LCPC, LMHC
Gender
Female
Entity Type
Individual
Location Address
1251 N EDDY ST STE 200 SOUTH BEND, IN 46617
Location Phone
(312) 798-9755
Mailing Address
1251 N EDDY ST STE 200 SOUTH BEND, IN 46617
Mailing Phone
(312) 798-9755
Medical School Name
OTHER
Graduation Year
2004
Is Sole Proprietor?
No
Enumeration Date
11-17-2016
Last Update Date
06-25-2025
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Location Map

Secondary Locations

  • 1251 N Eddy St Ste 200
    South Bend, IN 46617
    (312) 798-9755

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

Counselor Professional

Taxonomy Code
101YP2500X
Type
Behavioral Health & Social Service Providers
License No.
39004648A
License State
IN

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1101YP2500XBehavioral Health & Social Service Providers

Counselor
Professional

180.011258 (IL)

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
  • UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
  • UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals) - EPO
  • UHC Bronze Standard (No Referrals) - EPO
  • UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - EPO
  • UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - EPO
  • UHC Gold Standard (No Referrals) - EPO
  • UHC Gold Value ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) - EPO
  • UHC Gold Value+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) - EPO
  • UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
  • UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
  • UHC Silver Standard (No Referrals) - EPO
  • UHC Silver Standard+ (Dental + Vision, No Referrals) - EPO
  • UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - EPO
  • UHC Silver Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - EPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Angela Jackson is registered with Medicare but maybe doesn't accept claims assignment. If you are a Medicare beneficiary call and confirm with the provider before seeking any services.

Angela 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 and Durable Medical Equipment (DME).

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

  • PECOS PAC ID: 5991295339

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20251110000562

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Maybe

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • 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): No

  • Eligible to Order or Refer Power Mobility Devices: No

Reviews for DR. ANGELA DECARLA JACKSON PH.D., LCPC, LMHC

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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 1194267476, we treat the final digit (6) 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 64. The final step is to find the difference between that total and the next multiple of ten (70 - 64 = 6).

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
9
Doubled → 18 → 1 + 8
Pos 4
4
Unchanged
Pos 5
2
Doubled → 4
Pos 6
6
Unchanged
Pos 7
7
Doubled → 14 → 1 + 4
Pos 8
4
Unchanged
Pos 9
7
Doubled → 14 → 1 + 4
Check
6
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 9 → 18 → 9 2 → 4 7 → 14 → 5 7 → 14 → 5

Step 2: Add all digits plus the NPI constant

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

2 + 1 + 1 + 8 + 4 + 4 + 6 + 1 + 4 + 4 + 1 + 4 + 24 = 64

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

The next multiple of ten after 64 is 70. The difference is the calculated check digit.

70 - 64 = 6
This NPI is valid
The calculated check digit is 6, which matches the last digit of 1194267476.

Other Providers at the Same Location


The following 13 providers are registered at the same or a nearby location.

Psychologist (Clinical)
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Psychologist
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Home Health
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Contractor
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Registered Nurse
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Counselor (Mental Health)
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Counselor (Mental Health)
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Technician, Pathology (Phlebotomy)
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Nurse Practitioner (Family)
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Behavior Analyst
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Behavior Analyst
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Counselor (Professional)
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617
Psychologist
1251 N EDDY ST STE 200
SOUTH BEND, IN 46617

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1194267476, enumerated as an "individual" on November 17, 2016.

The provider is located at 1251 N EDDY ST STE 200 SOUTH BEND, IN 46617 and the phone number is (312) 798-9755.

Counselor with taxonomy code 101YP2500X and a focus in Professional.

The provider might be accepting Accepts: UnitedHealthcare. Please consult your insurance carrier or call the provider to verify.