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MRS. JACKLYN SAMUELS LPC
NPI 1689289100
Counselor - Mental Health in Sandusky, OH

Active since September 11, 2020PECOS EnrolledAccepts Medicare Assignment
1925 HAYES AVE, SANDUSKY, OH 44870(419) 557-5177 Get Directions Write a Review

NPPES record last updated: October 12, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Oct 12, 2021, Sep 11, 2020 (2 updates tracked since 2020).

About Mrs. Jacklyn Samuels Lpc NPPES

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

MRS. JACKLYN SAMUELS LPC (NPI 1689289100) is an individual mental health provider in Sandusky, Ohio, licensed in Ohio (C.2103762) and active in the NPI registry since September 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1689289100
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameMRS. JACKLYN SAMUELSCredential: LPC
Location Address1925 HAYES AVESandusky, OH 44870-4737
Mailing Address675 Bartson RdFremont, OH 43420-9672 · (419) 332-5524
Phone(419) 557-5177
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateSeptember 11, 2020
Last NPPES UpdateOctober 12, 20212 updates tracked since enumeration
NPPES CertifiedOctober 12, 2021
✔ NPI 1689289100 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in OH · C.2103762
Also ListedCounselorTaxonomy 101Y00000X · License C.2002650-TRNE (OH)
1925 HAYES AVE, Sandusky, OH 44870
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.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

Mrs. Jacklyn Samuels Lpc 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 ID8325531023
PECOS Enrollment IDI20251202001376
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 Jacklyn Samuels reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

J. Kilby Enterprises, Inc.
147 mi
Mental Health
955 CONGRESS PARK DR
Centerville, OH 45459
  • Reassigned Medicare billing, Ohio enrollment
  • 18 clinicians in this Medicare group
NPI 1316652894 (937) 320-1020

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

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.

MS. ADA M BLOOM LISW
Social Worker (Clinical)
1925 HAYES AVE
SANDUSKY, OH 44870
Erie County (419) 557-5177
CURSTIN CJEM HACKENBURG
Case Manager/Care Coordinator
1925 HAYES AVE
SANDUSKY, OH 44870
Erie County (419) 557-5177
GAVIN LEE WINTERS
Counselor (Mental Health)
1925 HAYES AVE
SANDUSKY, OH 44870
Erie County (419) 557-5177
MISS BROOKE NICOLE POLAK
Case Manager/Care Coordinator
1925 HAYES AVE
SANDUSKY, OH 44870
Erie County (419) 557-5177
ELLIE NICOLE SOUTHWARD
Counselor
1925 HAYES AVE
SANDUSKY, OH 44870
Erie County (419) 557-5177
ALISSA HARVEY
Case Manager/Care Coordinator
1925 HAYES AVE
SANDUSKY, OH 44870
Erie County (419) 557-5177
HANNAH J FLEMING LSW
Social Worker
1925 HAYES AVE
SANDUSKY, OH 44870
Erie County (419) 557-5177
KIMBERLY MARY DUNPHY LPC
Counselor (Mental Health)
1925 HAYES AVE
SANDUSKY, OH 44870
Erie County (419) 557-5177

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 Jacklyn Samuels's NPI number?

The NPI number for Jacklyn Samuels is 1689289100. It was assigned to this individual provider in the NPPES registry on September 11, 2020.

Where is Jacklyn Samuels located?

Jacklyn Samuels practices at 1925 Hayes Ave, Sandusky, OH 44870. The listed phone number is (419) 557-5177.

What is Jacklyn Samuels's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Jacklyn Samuels enrolled in Medicare?

Yes. Jacklyn Samuels 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 Jacklyn Samuels's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacklyn Samuels reassigns Medicare benefits to J. Kilby Enterprises, Inc. (Centerville, OH). 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 Jacklyn Samuels's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jacklyn Samuels accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and CareSource and 2 other insurers list Jacklyn Samuels 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.

When was this NPI record last updated?

The NPPES record for Jacklyn Samuels was last updated on October 12, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.