MARY MARIE JACKSON PMHNP-BC
NPI 1215637301
Nurse Practitioner - Psychiatric/Mental Health in Anderson, SC

Q: What is Mary Jackson's NPI number?

The NPI number for Mary Jackson is 1215637301. It was assigned to this individual provider in the NPPES registry on March 7, 2023.

Q: What is Mary Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Mary Jackson was last updated on November 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 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.

Active since March 07, 2023PECOS EnrolledAccepts Medicare Assignment

102 BUFORD AVE STE A, ANDERSON, SC 29621(864) 280-6551 Get Directions Write a Review

NPPES record last updated: November 8, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 8, 2024, May 13, 2023, Mar 31, 2023 and 1 more (4 updates tracked since 2023).

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About Mary Marie Jackson Pmhnp-bc NPPES

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

MARY MARIE JACKSON PMHNP-BC (NPI 1215637301) is an individual psychiatric/mental health provider in Anderson, South Carolina, licensed in South Carolina (27133) and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1215637301

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameMARY MARIE JACKSONCredential: PMHNP-BC

Location Address102 BUFORD AVE STE AAnderson, SC 29621-3365

Mailing Address102 Buford Ave Ste AAnderson, SC 29621-3365 · (864) 261-9506

Phone(864) 280-6551

Sole ProprietorYes

Medical School CMSOtherGraduated 2022

Enumeration DateMarch 7, 2023

Last NPPES UpdateNovember 8, 20244 updates tracked since enumeration

NPPES CertifiedNovember 8, 2024

✔ NPI 1215637301 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in SC · 27133

102 BUFORD AVE STE A, Anderson, SC 29621

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of North Carolina and more.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

Mary Marie Jackson Pmhnp-bc 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 ID8022465756

PECOS Enrollment IDI20231116003390

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

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

Upstate Wellness Center LLC

Same address

Psychiatry

102 BUFORD AVE STE A
Anderson, SC 29621

Reassigned Medicare billing, South Carolina enrollment
15 clinicians in this Medicare group

NPI 1871362459 (864) 261-9506

Anmed Health

Same address

Cardiovascular Disease

105 BUFORD AVE
Anderson, SC 29621

Reassigned Medicare billing, South Carolina enrollment
Also billed through NPI 1629843099 (South Carolina)
381 clinicians in this Medicare group

NPI 1588965206 (864) 375-0667

Ernest C. Martin, M.D., P.A.

2.8 mi

Psychiatry

309 W BELTLINE BLVD, NORTH HILL PROFESSIONAL PARK
Anderson, SC 29625

Reassigned Medicare billing, South Carolina enrollment
11 clinicians in this Medicare group

NPI 1871555896 (864) 261-9506

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 3

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.

Psychotherapy with evaluation and management visit, 30 minutes 90833

Psychotherapy with evaluation and management is a 30-minute session where a mental health professional talks with you about your concerns and feelings. They assess your mental health, provide support, and manage your treatment plan to help improve your well-being.

120 services52 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

93 services43 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

29 services26 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29621 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

$83.18 typical visit price

range $53.57 – $163.84

Typical copayment $20.79 (range $13.39 – $40.96)

Most-billed visit code 99203

Established Patient

$95.12 typical visit price

range $16.96 – $133.52

Typical copayment $23.78 (range $4.24 – $33.38)

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.

ASHLEY POTTER

Nurse Practitioner (Psychiatric/Mental Health)