SAMUEL JACKSON
NPI 1255794160
Psychiatry & Neurology - Psychiatry in Boston, MA
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
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 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.
Medicare Billing Reassignment
Medicare enrollment records show Samuel Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Boston, MA 02118
- Reassigned Medicare billing, Massachusetts enrollment
- 193 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.
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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Boston Medical Center
Acute Care Hospitals · Boston, MAPhysician 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.
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.
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.
BOSTON, MA 02118
BOSTON, MA 02118
BOSTON, MA 02118
BOSTON, MA 02118
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.
Which organization bills Medicare for Samuel Jackson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Jackson reassigns Medicare benefits to Boston University Psychiatry Associates, Inc. (Boston, MA). 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 Samuel Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Samuel Jackson accept?
Health plans from Harvard Pilgrim Health Care, Taro Health and WellSense Health Plan 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.
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 12 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.
# Samuel Jackson · NPI 1255794160
Psychiatry physician in Boston, Massachusetts. Individual provider, active in the CMS NPPES registry since March 30, 2016.
## Identity
- **NPI:** 1255794160 (Entity type: Individual)
- **Enumerated:** March 30, 2016
- **Primary specialty:** Psychiatry & Neurology - Psychiatry · taxonomy 2084P0800X
- **State license:** 1023020 (Massachusetts)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1 BOSTON MEDICAL CTR PL, Boston, MA 02118-2908
- **Phone:** (617) 414-5245
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Boston University Psychiatry Associates, Inc. (NPI 1073619854, Boston, MA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2016
## Record status
- **NPPES last updated:** October 3, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1255794160) · Data from the CMS NPPES public registry.