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DR. REYNALDO JACKSON DMD
NPI 1407435696
Dentist - General Practice in Chicago, IL

Active since April 05, 2021PECOS Enrolled
9521 S WESTERN AVE, CHICAGO, IL 60643(773) 344-9120 Get Directions Write a Review

NPPES record last updated: September 12, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 12, 2025, Nov 7, 2022, Apr 5, 2021 (3 updates tracked since 2021).

About Dr. Reynaldo Jackson Dmd NPPES

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

DR. REYNALDO JACKSON DMD (NPI 1407435696) is an individual general practice provider in Chicago, Illinois, licensed in Illinois (019.036510) and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS and maintains a secondary practice location in Lakewood.

NPPES Registry Identity

NPI1407435696
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. REYNALDO JACKSONCredential: DMD
Location Address9521 S WESTERN AVEChicago, IL 60643-1013
Mailing Address10510 Gravelly Lake Dr SwLakewood, WA 98499-5036 · (253) 589-7030
Phone(773) 344-9120
Sole ProprietorNo
Enumeration DateApril 5, 2021
Last NPPES UpdateSeptember 12, 20253 updates tracked since enumeration
NPPES CertifiedSeptember 12, 2025
✔ NPI 1407435696 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in IL · 019.036510
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Also ListedDentistTaxonomy 122300000X · License DE61346798 (WA)
9521 S WESTERN AVE, Chicago, IL 60643
Open in Google Maps ↗

Secondary Practice Location 1

Location 110510 Gravelly Lake Dr SWLakewood, WA 98499-5036 · Phone (253) 589-7030

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Reynaldo Jackson Dmd 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60643 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
$94.06 typical visit price
range $60.08 – $183.39
Typical copayment $23.51 (range $15.02 – $45.84)
Most-billed visit code 99203
Established Patient
$74.80 typical visit price
range $18.97 – $148.12
Typical copayment $18.70 (range $4.74 – $37.03)
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 4

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

KABILA RAMKUMAR DMD
Dentist (General Practice)
9521 S WESTERN AVE
CHICAGO, IL 60643
Cook County (773) 344-9120
ALEXANDRA KIDD
Dentist (General Practice)
9521 S WESTERN AVE
CHICAGO, IL 60643
Cook County (773) 344-9120
DR. KEVIN WILSON DDS
Dentist (General Practice)
9521 S WESTERN AVE
CHICAGO, IL 60643
Cook County (773) 344-9120
SERINA SALAH DMD
Dentist
9521 S WESTERN AVE
CHICAGO, IL 60643
Cook County (773) 344-9120

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 Reynaldo Jackson's NPI number?

The NPI number for Reynaldo Jackson is 1407435696. It was assigned to this individual provider in the NPPES registry on April 5, 2021.

Where is Reynaldo Jackson located?

Reynaldo Jackson practices at 9521 S Western Ave, Chicago, IL 60643. The listed phone number is (773) 344-9120.

What is Reynaldo Jackson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Reynaldo Jackson enrolled in Medicare?

Yes. Reynaldo Jackson is registered in the Medicare PECOS enrollment system.

What insurance does Reynaldo Jackson accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health, Anthem Blue Cross and Blue Shield and BEST Life and 9 other insurers list Reynaldo 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.

When was this NPI record last updated?

The NPPES record for Reynaldo Jackson was last updated on September 12, 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.