SAMUEL JACKSON
NPI 1255794160
Psychiatry & Neurology - Psychiatry in Boston, MA

Q: What is Samuel Jackson's NPI number?

The NPI number for Samuel Jackson is 1255794160. It was assigned to this individual provider in the NPPES registry on March 30, 2016.

Q: What is Samuel Jackson's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Q: When was this NPI record last updated?

The NPPES record for Samuel Jackson was last updated on October 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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 30, 2016PECOS EnrolledAccepts Medicare Assignment

93.09/100

CMS Quality Rating

1 BOSTON MEDICAL CTR PL, BOSTON, MA 02118(617) 414-5245 Get Directions Write a Review

NPPES record last updated: October 3, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Aug 25, 2022, Jul 14, 2021, Mar 24, 2020 and 1 more (4 updates tracked since 2016).

On this page

About Samuel Jackson NPPES

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

SAMUEL JACKSON (NPI 1255794160) is an individual psychiatry provider in Boston, Massachusetts, licensed in Massachusetts (1023020) and active in the NPI registry since March 2016. He is enrolled in Medicare PECOS, is affiliated with Boston Medical Center, and maintains a secondary practice location in Seattle.

NPPES Registry Identity

NPI1255794160

Entity TypeIndividualMale

Primary Taxonomy2084P0800X

Provider Legal NameSAMUEL JACKSON

Location Address1 BOSTON MEDICAL CTR PLBoston, MA 02118-2908

Mailing Address960 Massachusetts Ave Ste 2Boston, MA 02118-2690

Phone(617) 414-5245

Sole ProprietorYes

Medical School CMSOtherGraduated 2016

Enumeration DateMarch 30, 2016

Last NPPES UpdateOctober 3, 20254 updates tracked since enumeration

NPPES CertifiedOctober 3, 2025

✔ NPI 1255794160 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

Licenses✔ Licensed in MA · 1023020✔ Licensed in WA · MD61035793

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

1 BOSTON MEDICAL CTR PL, Boston, MA 02118

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Secondary Practice Location 1

Location 1825 Eastlake Ave ESeattle, WA 98109-4405 · Phone (206) 520-5000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Harvard Pilgrim Health Care.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Samuel Jackson 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 ID7012209471

PECOS Enrollment IDI20251008003961

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.

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.

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.

105 services30 patients

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.

44 services18 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Boston Medical Center

Acute Care Hospitals · Boston, MA

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number220031

Location1 Boston Medical Center PlaceBoston, MA 02118 · Suffolk County

Emergency services Birthing friendly

Harborview Medical Center

Acute Care Hospitals · Seattle, WA

1/5 CMS rating

OwnershipGovernment - Local

CMS Certification Number500064

Location325 9th AvenueSeattle, WA 98104 · King County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02118 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

$189.86 typical visit price

range $63.72 – $189.86

Typical copayment $47.46 (range $15.93 – $47.46)

Most-billed visit code 99205

Established Patient

$78.84 typical visit price

range $21.07 – $155.29

Typical copayment $19.71 (range $5.26 – $38.82)

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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

93.09/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored through an Alternative Payment Model

Quality

73.95

Promoting Interoperability

100

Improvement Activities

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.

SOPHIA N. TOWNSEND CRNA

Nurse Anesthetist, Certified Registered

1 BOSTON MEDICAL CTR PL
BOSTON, MA 02118

Suffolk County (617) 638-6950

MADELYN ROSE CHAMIS

Physician Assistant

1 BOSTON MEDICAL CTR PL
BOSTON, MA 02118

Suffolk County (617) 638-8000

DR. NICKKI P DAWES

Psychologist (Clinical)

1 BOSTON MEDICAL CTR PL
BOSTON, MA 02118

Suffolk County (617) 414-5245

COMFORT ATWEREBOANAH

Nurse Practitioner (Psychiatric/Mental Health)

1 BOSTON MEDICAL CTR PL
BOSTON, MA 02118

Suffolk County (617) 414-5245

SOFIA PHAM

Student in an Organized Health Care Education/Training Program

1 BOSTON MEDICAL CTR PL
BOSTON, MA 02118

Suffolk County (617) 638-8000

ANEESH T NARANG MD

Emergency Medicine

1 BOSTON MEDICAL CTR PL, DOWLING 1 SOUTH
BOSTON, MA 02118

Suffolk County (617) 414-5481

TEMITAYO OKUBANJO PHARM.D, BCPS

Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)

1 BOSTON MEDICAL CTR PL
BOSTON, MA 02118

Suffolk County (617) 638-8000

DEBORAH A DAVOLIO NP

Nurse Practitioner

1 BOSTON MEDICAL CTR PL, DOWLING 1 SOUTH
BOSTON, MA 02118

Suffolk County (617) 414-5481

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 Samuel Jackson's NPI number?

The NPI number for Samuel Jackson is 1255794160. It was assigned to this individual provider in the NPPES registry on March 30, 2016.

Where is Samuel Jackson located?

Samuel Jackson practices at 1 Boston Medical Ctr Pl, Boston, MA 02118. The listed phone number is (617) 414-5245.

What is Samuel Jackson's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Is Samuel Jackson enrolled in Medicare?

Yes. Samuel 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.

What insurance does Samuel Jackson accept?

Health plans from Harvard Pilgrim Health Care list Samuel 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.

Is Samuel Jackson affiliated with any hospitals?

According to CMS data, Samuel Jackson is affiliated with Boston Medical Center and Harborview Medical Center.

When was this NPI record last updated?

The NPPES record for Samuel Jackson was last updated on October 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.