1. Home
  2. Directory
  3. Maryland
  4. Waldorf
  5. Nurse Practitioner
  6. NPI Profile

MS. JACKIE AGNESS GONZALEZ
NPI 1407670094
Nurse Practitioner - Psychiatric/Mental Health in Waldorf, MD

Active since November 11, 2024PECOS Enrolled
4307 EAGLE TRACE CT, WALDORF, MD 20602(301) 351-7881 Get Directions Write a Review

NPPES record last updated: November 11, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Ms. Jackie Agness Gonzalez NPPES

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

MS. JACKIE AGNESS GONZALEZ (NPI 1407670094) is an individual psychiatric/mental health provider in Waldorf, Maryland, licensed in Maryland (R131587) and active in the NPI registry since November 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2016).

NPPES Registry Identity

NPI1407670094
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameMS. JACKIE AGNESS GONZALEZ
Location Address4307 EAGLE TRACE CTWaldorf, MD 20602-3116
Mailing Address4307 Eagle Trace CtWaldorf, MD 20602-3116 · (301) 351-7881
Phone(301) 351-7881
Sole ProprietorNo
Medical School CMSOtherGraduated 2016
Enumeration DateNovember 11, 2024
NPPES CertifiedNovember 11, 2024
✔ NPI 1407670094 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 MD · R131587
4307 EAGLE TRACE CT, Waldorf, MD 20602
Open in Google Maps ↗

Other Names 1

Professional Name (2)Ms. Jackie Gonzalez

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Jackie Agness Gonzalez is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID840757498
PECOS Enrollment IDI20260804003436
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 Jackie Gonzalez reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Zeal Mental Health & Wellness Center LLC
Same address
Psychiatric/Mental Health
4307 EAGLE TRACE CT
Waldorf, MD 20602
  • Reassigned Medicare billing, Maryland enrollment
NPI 1861353088 (301) 818-3805

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 20602 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
$89.75 typical visit price
range $57.99 – $175.57
Typical copayment $22.43 (range $14.49 – $43.89)
Most-billed visit code 99203
Established Patient
$102.11 typical visit price
range $18.66 – $143.02
Typical copayment $25.52 (range $4.66 – $35.75)
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

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

ZEAL MENTAL HEALTH & WELLNESS CENTER LLC
Nurse Practitioner (Psychiatric/Mental Health)
4307 EAGLE TRACE CT
WALDORF, MD 20602
Charles County (301) 818-3805

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 Jackie Gonzalez's NPI number?

The NPI number for Jackie Gonzalez is 1407670094. It was assigned to this individual provider in the NPPES registry on November 11, 2024. The provider is also known as Ms. Jackie Gonzalez.

Where is Jackie Gonzalez located?

Jackie Gonzalez practices at 4307 Eagle Trace Ct, Waldorf, MD 20602. The listed phone number is (301) 351-7881.

What is Jackie Gonzalez's specialty?

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

Is Jackie Gonzalez enrolled in Medicare?

Yes. Jackie Gonzalez is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jackie Gonzalez's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jackie Gonzalez reassigns Medicare benefits to Zeal Mental Health & Wellness Center LLC (Waldorf, MD). 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 Jackie Gonzalez'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 Jackie Gonzalez was last updated on November 11, 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.