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CHANELL SHANNON JACKSON NMW, WHNP
NPI 1356011597
Midwife in Culver City, CA

Active since September 19, 2021PECOS EnrolledAccepts Medicare Assignment
5883 1/2 DOVERWOOD DR, CULVER CITY, CA 90230(310) 848-7736 Get Directions Write a Review

NPPES record last updated: March 30, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Chanell Shannon Jackson Nmw, Whnp NPPES

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

CHANELL SHANNON JACKSON NMW, WHNP (NPI 1356011597) is an individual midwife in Culver City, California, licensed in California (236061) and active in the NPI registry since September 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1356011597
Entity TypeIndividualFemale
Primary Taxonomy176B00000X
Provider Legal NameCHANELL SHANNON JACKSONCredential: NMW, WHNP
Location Address5883 1/2 DOVERWOOD DRCulver City, CA 90230-7203
Mailing Address5883 1/2 Doverwood DrCulver City, CA 90230-7203 · (310) 848-7736
Phone(310) 848-7736
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateSeptember 19, 2021
Last NPPES UpdateMarch 30, 2022
NPPES CertifiedSeptember 19, 2021
✔ NPI 1356011597 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMidwifeOther Service Providers
Taxonomy Code176B00000X
License✔ Licensed in CA · 236061
Definition
A Midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling, and support to a woman and her newborn throughout the childbearing cycle. A Midwife is a skilled and independent practitioner who has undergone formalized training. Midwives are not required to be nurses and may be trained via multiple routes of education (apprenticeship, workshop, formal classes, or programs, etc., usually a combination). The educational background requirements and licensing requirements vary by state. The Midwife may or may not be certified by a state or national organization.
Also ListedNurse Practitioner · Women's HealthTaxonomy 363LW0102X · License 236061 (CA)
5883 1/2 DOVERWOOD DR, Culver City, CA 90230
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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

Chanell Shannon Jackson Nmw, Whnp 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 ID7911393723
PECOS Enrollment IDI20220404002229
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 Chanell Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
37 mi
Clinical Medical Laboratory
13000 PEYTON DR
Chino Hills, CA 91709
  • Reassigned Medicare billing, California enrollment
  • 5,228 clinicians in this Medicare group
NPI 1396287082 (888) 750-0036

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

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 Chanell Jackson's NPI number?

The NPI number for Chanell Jackson is 1356011597. It was assigned to this individual provider in the NPPES registry on September 19, 2021.

Where is Chanell Jackson located?

Chanell Jackson practices at 5883 1/2 Doverwood Dr, Culver City, CA 90230. The listed phone number is (310) 848-7736.

What is Chanell Jackson's specialty?

The primary specialty registered for this NPI is Midwife with taxonomy code 176B00000X.

Is Chanell Jackson enrolled in Medicare?

Yes. Chanell 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 Chanell Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Chanell Jackson reassigns Medicare benefits to Southern California Permanente Medical Group (Chino Hills, CA). 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 Chanell Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Chanell Jackson was last updated on March 30, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.