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DR. JACKSON NEWSOME PSYD
NPI 1740944438
Psychologist - Clinical in Chicago, IL

Active since October 28, 2021Opted out of Medicare · through Dec 27, 2026
1331 N BOSWORTH AVE APT 3, CHICAGO, IL 60642(773) 683-3200 Get Directions Write a Review

NPPES record last updated: October 12, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Jackson Newsome Psyd NPPES

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

DR. JACKSON NEWSOME PSYD (NPI 1740944438) is an individual clinical provider in Chicago, Illinois, licensed in Illinois (071010649) and active in the NPI registry since October 2021. He has opted out of Medicare through December 27, 2026 and maintains a secondary practice location in Chicago.

NPPES Registry Identity

NPI1740944438
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NameDR. JACKSON NEWSOMECredential: PSYD
Location Address1331 N BOSWORTH AVE APT 3Chicago, IL 60642-3421
Mailing Address1331 N Bosworth Ave Apt 3Chicago, IL 60642-3421 · (773) 683-3200
Phone(773) 683-3200
Sole ProprietorYes
Enumeration DateOctober 28, 2021
Last NPPES UpdateOctober 12, 2023
NPPES CertifiedOctober 11, 2023
✔ NPI 1740944438 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 IL · 071010649
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.
1331 N BOSWORTH AVE APT 3, Chicago, IL 60642
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Secondary Practice Location 1

Location 12500 W Bradley Pl Ste 210Chicago, IL 60618-4716 · Phone (773) 683-3200

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jackson Newsome Psyd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 27, 2022 through December 27, 2026.

Opt-Out Effective DateDecember 27, 2022
Opt-Out In Effect ThroughDecember 27, 2026Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES

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

FORGE PSYCHOLOGY CHICAGO, PLLC
Psychologist (Clinical)
1331 N BOSWORTH AVE APT 3
CHICAGO, IL 60642
Cook County (773) 683-3200

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 Jackson Newsome's NPI number?

The NPI number for Jackson Newsome is 1740944438. It was assigned to this individual provider in the NPPES registry on October 28, 2021.

Where is Jackson Newsome located?

Jackson Newsome practices at 1331 N Bosworth Ave Apt 3, Chicago, IL 60642. The listed phone number is (773) 683-3200.

What is Jackson Newsome's specialty?

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

Is Jackson Newsome enrolled in Medicare?

No. Jackson Newsome has opted out of Medicare through December 27, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Jackson Newsome was last updated on October 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.