WALLACE J JACKMON PHD
NPI 1427020957
Psychologist - Clinical in Sioux Falls, SD

Q: 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.

Q: What is Wallace Jackmon's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: 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 7 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.

Active since February 07, 2006PECOS EnrolledAccepts Medicare Assignment

4400 W 69TH ST, STE 1500, SIOUX FALLS, SD 57108(605) 322-5700(605) 322-5704 Get Directions Write a Review

NPPES record last updated: October 11, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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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

NPI1427020957

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameWALLACE J JACKMONCredential: PHD

Location Address4400 W 69TH ST, STE 1500Sioux Falls, SD 57108-8170

Mailing AddressPo Box 86370Sioux Falls, SD 57118-6370 · (605) 322-7510 · Fax (605) 322-6475

Phone(605) 322-5700

Fax(605) 322-5704

Sole ProprietorNo

Medical School CMSOtherGraduated 2007

Enumeration DateFebruary 7, 2006

Last NPPES UpdateOctober 11, 2018

✔ NPI 1427020957 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in SD · 477

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

4400 W 69TH ST, Sioux Falls, SD 57108

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Other Identifiers 18

Other040121002MN · Primewest

Other854000SD · Araz/ America's Ppo

Medicaid3989442IA

Other800013808SD · Rr Medicare

OtherHP37115SD · Healthpartners

Other0040537SD · Blue Cross

Medicaid12200ND

Medicaid6570753SD

Medicaid944611700MN

Other20814SD · Sanford Health Plan

Medicaid46022474352NE

Other142415MN · Ucare

Other412991020844SD · Preferred One

Other57108C003SD · Wps Tricare

Other140M8JAMN · Cc Systems/ Blue Plus

Other15096SD · Midlands Choice

Other9205351SD · Dakotacare

Medicaid6552790SD

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter from Sunflower Health Plan, Ambetter Health 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 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.

PECOS PAC ID6709896467

PECOS Enrollment IDI20060426000452

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.

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.

Psychotherapy, 1 hour 90837

Psychotherapy is a therapeutic interaction or treatment between a trained professional and a patient. In a 1-hour session, you'll talk about your feelings, thoughts, and behaviors to help identify and manage mental health issues. This process aids in personal growth, healing, and improved well-being.

166 services16 patients

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, SD

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number430016

Location1325 S Cliff AveSioux Falls, SD 57117 · Minnehaha County

Emergency services Birthing friendly

Physician 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.

New Patient

$167.23 typical visit price

range $55.52 – $167.23

Typical copayment $41.80 (range $13.88 – $41.80)

Most-billed visit code 99205

Established Patient

$97.88 typical visit price

range $18.08 – $137.08

Typical copayment $24.47 (range $4.52 – $34.27)

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 20

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

AMBER OLSON MD

Psychiatry & Neurology (Psychiatry)

4400 W 69TH ST
SIOUX FALLS, SD 57108

Lincoln County (605) 322-4005

AMANDA CHARLENE NOONAN DNP

Nurse Practitioner (Psychiatric/Mental Health)

4400 W 69TH ST
SIOUX FALLS, SD 57108

Lincoln County (605) 322-4005

JOSHUA REIDER MD

Psychiatry & Neurology (Psychiatry)

4400 W 69TH ST
SIOUX FALLS, SD 57108

Lincoln County (605) 322-5737

KARA FEISTNER FNP-C

Student in an Organized Health Care Education/Training Program

4400 W 69TH ST
SIOUX FALLS, SD 57108

Lincoln County (605) 322-4065

TIMOTHY JAMES SOUNDY M.D.

Psychiatry & Neurology (Child & Adolescent Psychiatry)

4400 W 69TH ST, STE 1500
SIOUX FALLS, SD 57108

Lincoln County (605) 322-5700

KYLE A DUKE PA

Physician Assistant

4400 W 69TH ST
SIOUX FALLS, SD 57108

Lincoln County (605) 322-4405

CANDICE K CUMMINGS LCSW, ISW

Counselor (Mental Health)

4400 W 69TH ST, STE 1500
SIOUX FALLS, SD 57108

Lincoln County (605) 322-5700

DR. ANNE ELIZABETH MORSTAD PHARMD

Pharmacist

4400 W 69TH ST, SUITE 1800
SIOUX FALLS, SD 57108

Lincoln County (605) 322-5912

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.

What insurance does Wallace Jackmon accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and Avera Health Plans and 1 other insurer 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 7 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.