DR. ANGELA DECARLA JACKSON PH.D., LCPC, LMHC
NPI 1194267476
Counselor - Professional in South Bend, IN
About Dr. Angela Decarla Jackson Ph.d., Lcpc, Lmhc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. ANGELA DECARLA JACKSON PH.D., LCPC, LMHC (NPI 1194267476) is an individual professional provider in South Bend, Indiana, licensed in Indiana (39004648A) and active in the NPI registry since November 2016. She is enrolled in Medicare PECOS, maintains a secondary practice location in South Bend, and is a graduate of Other (2004).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Angela Decarla Jackson Ph.d., Lcpc, Lmhc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Angela Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Miami, FL 33130
- Reassigned Medicare billing, Illinois and Indiana enrollments
- 581 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 12
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SOUTH BEND, IN 46617
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 Angela Jackson's NPI number?
The NPI number for Angela Jackson is 1194267476. It was assigned to this individual provider in the NPPES registry on November 17, 2016.
Where is Angela Jackson located?
Angela Jackson practices at 1251 N Eddy St Ste 200, South Bend, IN 46617. The listed phone number is (312) 798-9755.
What is Angela Jackson's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Angela Jackson enrolled in Medicare?
Yes. Angela Jackson is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Angela Jackson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Angela Jackson reassigns Medicare benefits to Grow Healthcare Group PA (Miami, FL). The 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 Angela Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Angela Jackson accept?
Health plans from Anthem Blue Cross and Blue Shield, Oscar Health, Oscar Health Maintenance Organization of Florida and UnitedHealthcare list Angela 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 Angela Jackson was last updated on June 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# Dr. Angela Decarla Jackson, PH.D., LCPC, LMHC · NPI 1194267476
Professional provider in South Bend, Indiana. Individual provider, active in the CMS NPPES registry since November 17, 2016.
## Identity
- **NPI:** 1194267476 (Entity type: Individual)
- **Enumerated:** November 17, 2016
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** 39004648A (Indiana)
- **Sole proprietor:** No
## Practice location
- **Address:** 1251 N EDDY ST STE 200, South Bend, IN 46617-1478
- **Phone:** (312) 798-9755
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Grow Healthcare Group PA (NPI 1245845932, Miami, FL), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2004
## Record status
- **NPPES last updated:** June 25, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1194267476) · Data from the CMS NPPES public registry.