MRS. TIENNA STEPHANIE JACKSON
NPI 1194976225
Social Worker - Clinical in San Diego, CA

Q: What is Tienna Jackson's NPI number?

The NPI number for Tienna Jackson is 1194976225. It was assigned to this individual provider in the NPPES registry on October 7, 2008.

Q: What is Tienna Jackson's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Tienna Jackson was last updated on June 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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 October 07, 2008PECOS Enrolled

3132 JEFFERSON ST, SAN DIEGO, CA 92110(619) 683-3100 Get Directions Write a Review

NPPES record last updated: June 27, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jun 27, 2024, Jun 6, 2019 (2 updates tracked since 2019).

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About Mrs. Tienna Stephanie Jackson NPPES

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

MRS. TIENNA STEPHANIE JACKSON (NPI 1194976225) is an individual clinical provider in San Diego, California, licensed in California (89122) and active in the NPI registry since October 2008. She is enrolled in Medicare PECOS and maintains a secondary practice location in Lemon Grove.

NPPES Registry Identity

NPI1194976225

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameMRS. TIENNA STEPHANIE JACKSON

Location Address3132 JEFFERSON STSan Diego, CA 92110-4421

Mailing Address3132 Jefferson StSan Diego, CA 92110-4421 · (619) 683-3100

Phone(619) 683-3100

Sole ProprietorNo

Enumeration DateOctober 7, 2008

Last NPPES UpdateJune 27, 20242 updates tracked since enumeration

NPPES CertifiedJune 27, 2024

✔ NPI 1194976225 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in CA · 89122

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Also ListedCounselorTaxonomy 101Y00000X

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

3132 JEFFERSON ST, San Diego, CA 92110

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Secondary Practice Location 1

Location 17828 BroadwayLemon Grove, CA 91945-1801 · Phone (619) 876-4470

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Tienna Stephanie Jackson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignment

Medicare enrollment records show Tienna Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Family Health Centers Of San Diego Inc

2.4 mi

Federally Qualified Health Center (FQHC)

4094 4TH AVE
San Diego, CA 92103

Reassigned Medicare billing, California enrollment
1,100 clinicians in this Medicare group

NPI 1629456900 (619) 515-2545

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92110 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

$0.00 typical visit price

range $62.10 – $184.71

Typical copayment $0.00 (range $15.52 – $46.17)

Most-billed visit code NA

Established Patient

$76.87 typical visit price

range $20.62 – $151.42

Typical copayment $19.21 (range $5.15 – $37.85)

Most-billed visit code 99213

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 20

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

ISRAEL Q LIM

Licensed Vocational Nurse