JACKSON WALL APCC, AMFT
NPI 1518577790
Counselor - Mental Health in Santa Monica, CA
NPI Status: Active since August 03, 2020
Contact Information
1450 20TH ST
SANTA MONICA, CA
ZIP 90404
Phone: (310) 309-6001
- Individual
- Male
- Counselor
- Mental Health
- Opted-Out Medicare
About JACKSON WALL
This page provides the complete NPI Profile along with additional information for Jackson Wall, a provider established in Santa Monica, California with a medical specialization in Counselor, focusing in mental health . The healthcare provider is registered in the NPI registry with number 1518577790 assigned on August 2020. The practitioner's primary taxonomy code is 101YM0800X with license number AMFT120524 (CA). The provider is registered as an individual and his NPI record was last updated 5 years ago.
- NPI
- 1518577790
- Provider Name
- JACKSON WALL APCC, AMFT
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 1450 20TH ST SANTA MONICA, CA 90404
- Location Phone
- (310) 309-6001
- Mailing Address
- PO BOX 1113 REDONDO BEACH, CA 90278
- Is Sole Proprietor?
- No
- Enumeration Date
- 08-03-2020
- Last Update Date
- 08-13-2020
- Code Navigator
A mental health counselor like Jackson Wall provides treatment to individuals, families, couples, and groups for mental and emotional health issues and relationship problems. Mental health counselors treat clients with a variety of conditions, including anxiety, depression, grief, low self-esteem, stress, and suicidal impulses.
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Jackson Wall opted out of Medicare effective on 01-01-2024 until 01-01-2026. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare and cannot order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Counselor Mental Health
- Taxonomy Code
- 101YM0800X
- Type
- Behavioral Health & Social Service Providers
- License No.
- AMFT120524
- License State
- CA
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | APCC8154 (CA) |
Medicare Participation & PECOS Enrollment Status
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 01-01-2024
Opt-Out End Date: 01-01-2026
Eligible to Order and Refer? No
Reviews for JACKSON WALL APCC, AMFT
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 5 | 1 | 8 | 5 | 7 | 7 | 7 | 9 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 5 | 2 | 8 | 10 | 7 | 14 | 7 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 5 + 2 + 8 + 1 + 0 + 7 + 1 + 4 + 7 + 1 + 8 + 24 = 70 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1518577790 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 6 providers are registered at the same or nearby location.
MRS. LISA MARIA JONES
Rehabilitation Counselor
1450 20TH ST
SANTA MONICA, CA
ZIP 90404
EDEN JULIET COMESS-DANIELS MSW CANDIDATE
Student in an Organized Health Care Education/Training Program
1450 20TH ST
SANTA MONICA, CA
ZIP 90404
MRS. CHELSEA KATZEMAN KWAN
Case Manager/Care Coordinator
1450 20TH ST
SANTA MONICA, CA
ZIP 90404
KATHERINE NARBUTAS
Student in an Organized Health Care Education/Training Program
1450 20TH ST
SANTA MONICA, CA
ZIP 90404
MR. CALVIN LEE
Student in an Organized Health Care Education/Training Program
1450 20TH ST
SANTA MONICA, CA
ZIP 90404
TAYLOR PILG
Case Manager/Care Coordinator
1450 20TH ST
SANTA MONICA, CA
ZIP 90404
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1518577790, enumerated as an "individual" on August 03, 2020.
The provider is located at 1450 20TH ST SANTA MONICA, CA 90404 and the phone number is (310) 309-6001.
Counselor with taxonomy code 101YM0800X and a focus in Mental Health.
