WALLACE J JACKMON PHD
NPI 1427020957
Psychologist - Clinical in Sioux Falls, SD
About Wallace J Jackmon Phd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WALLACE J JACKMON PHD (NPI 1427020957) is an individual clinical provider in Sioux Falls, South Dakota, licensed in South Dakota (477) and active in the NPI registry since February 2006. He is enrolled in Medicare PECOS, is affiliated with Avera Mckennan Hospital & University Health Center, and is a graduate of Other (2007).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 18
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
Wallace J Jackmon Phd 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 Wallace Jackmon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Brookings, SD 57006
- Reassigned Medicare billing, South Dakota enrollment
- 111 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
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.
Avera Mckennan Hospital & University Health Center
Acute Care Hospitals · Sioux Falls, SDPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 57108 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
SIOUX FALLS, SD 57108
SIOUX FALLS, SD 57108
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 Wallace Jackmon's NPI number?
The NPI number for Wallace Jackmon is 1427020957. It was assigned to this individual provider in the NPPES registry on February 7, 2006.
Where is Wallace Jackmon located?
Wallace Jackmon practices at 4400 W 69th St Ste 1500, Sioux Falls, SD 57108. The listed phone number is (605) 322-5700.
What is Wallace Jackmon's specialty?
The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.
Is Wallace Jackmon enrolled in Medicare?
Yes. Wallace Jackmon 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 Wallace Jackmon's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Wallace Jackmon reassigns Medicare benefits to Rural Health Care, Inc (Brookings, SD). 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 Wallace Jackmon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Wallace Jackmon accept?
Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Sunflower Health Plan, Avera Health Plans and Sanford Health Plan and 2 other insurers list Wallace Jackmon 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 Wallace Jackmon affiliated with any hospitals?
According to CMS data, Wallace Jackmon is affiliated with Avera Mckennan Hospital & University Health Center.
When was this NPI record last updated?
The NPPES record for Wallace Jackmon was last updated on October 11, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.
# Wallace J Jackmon, PHD · NPI 1427020957
Clinical provider in Sioux Falls, South Dakota. Individual provider, active in the CMS NPPES registry since February 7, 2006.
## Identity
- **NPI:** 1427020957 (Entity type: Individual)
- **Enumerated:** February 7, 2006
- **Primary specialty:** Psychologist - Clinical · taxonomy 103TC0700X
- **State license:** 477 (South Dakota)
- **Sole proprietor:** No
## Practice location
- **Address:** 4400 W 69TH ST, STE 1500, Sioux Falls, SD 57108-8170
- **Phone:** (605) 322-5700 · **Fax:** (605) 322-5704
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Rural Health Care, Inc (NPI 1386254191, Brookings, SD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2007
## Record status
- **NPPES last updated:** October 11, 2018
- **Other identifiers:** Other 040121002 (MN); Other 854000 (SD); Medicaid 3989442 (IA); and 15 more
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Source: [NPI Profile](https://npiprofile.com/npi/1427020957) · Data from the CMS NPPES public registry.