SAMUEL BARRETT JACKSON MD
NPI 1689105223
Internal Medicine - Cardiovascular Disease in Burlingame, CA
About Samuel Barrett Jackson Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMUEL BARRETT JACKSON MD (NPI 1689105223) is an individual cardiovascular disease provider in Burlingame, California, licensed in California (A163124) and active in the NPI registry since March 2017. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of University Of California, Geffen School Of Medicine (2017).
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Locations 2
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
Samuel Barrett Jackson Md 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 Reassignments
2Medicare enrollment records show Samuel Jackson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
San Carlos, CA 94070
- Reassigned Medicare billing, California enrollment
- Also billed through NPI 1013950807 (California), NPI 1982845186 (California), NPI 1568851327 (California), NPI 1497996524 (California), NPI 1033817168 (California)
- 393 clinicians in this Medicare group
Los Angeles, CA 90095
- Reassigned Medicare billing, California enrollment
- 1,766 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 94010 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.
BURLINGAME, CA 94010
BURLINGAME, CA 94010
BURLINGAME, CA 94010
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 Samuel Jackson's NPI number?
The NPI number for Samuel Jackson is 1689105223. It was assigned to this individual provider in the NPPES registry on March 24, 2017.
Where is Samuel Jackson located?
Samuel Jackson practices at 1501 Trousdale Dr, Burlingame, CA 94010. The listed phone number is (650) 652-8600.
What is Samuel Jackson's specialty?
The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.
Is Samuel Jackson enrolled in Medicare?
Yes. Samuel Jackson 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 organizations bill Medicare for Samuel Jackson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Jackson reassigns Medicare benefits to 2 organizations: Sutter Bay Medical Foundation (San Carlos, CA) and The Regents Of The University Of California (Los Angeles, CA). Each 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 Samuel Jackson'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 Samuel Jackson was last updated on September 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.
# Samuel Barrett Jackson, MD · NPI 1689105223
Cardiovascular Disease physician in Burlingame, California. Individual provider, active in the CMS NPPES registry since March 24, 2017.
## Identity
- **NPI:** 1689105223 (Entity type: Individual)
- **Enumerated:** March 24, 2017
- **Primary specialty:** Internal Medicine - Cardiovascular Disease · taxonomy 207RC0000X
- **State license:** A163124 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 1501 TROUSDALE DR, Burlingame, CA 94010-4506
- **Phone:** (650) 652-8600
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Sutter Bay Medical Foundation (NPI 1164840088, San Carlos, CA); The Regents Of The University Of California (NPI 1235107566, Los Angeles, CA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of California, Geffen School Of Medicine, class of 2017
## Record status
- **NPPES last updated:** September 23, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1689105223) · Data from the CMS NPPES public registry.