MICHAEL DEANGELO JACKSON NURSE PRACTITIONER
NPI 1821879958
Nurse Practitioner - Psychiatric/Mental Health in Long Beach, CA

Q: What is Michael Jackson's NPI number?

The NPI number for Michael Jackson is 1821879958. It was assigned to this individual provider in the NPPES registry on October 13, 2023.

Q: What is Michael Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Michael Jackson was last updated on April 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since October 13, 2023PECOS EnrolledAccepts Medicare Assignment

333 W BROADWAY STE 310, LONG BEACH, CA 90802(562) 491-6465 Get Directions Write a Review

NPPES record last updated: April 13, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 13, 2026, Jan 13, 2026, Oct 13, 2023 (3 updates tracked since 2023).

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About Michael Deangelo Jackson Nurse Practitioner NPPES

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

MICHAEL DEANGELO JACKSON NURSE PRACTITIONER (NPI 1821879958) is an individual psychiatric/mental health provider in Long Beach, California, licensed in California (95027684) and active in the NPI registry since October 2023. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1821879958

Entity TypeIndividualMale

Primary Taxonomy363LP0808X

Provider Legal NameMICHAEL DEANGELO JACKSONCredential: NURSE PRACTITIONER

Location Address333 W BROADWAY STE 310Long Beach, CA 90802-4438

Mailing Address3835 N Freeway Blvd Ste 100Sacramento, CA 95834-1954

Phone(562) 491-6465

Sole ProprietorYes

Medical School CMSOtherGraduated 2023

Enumeration DateOctober 13, 2023

Last NPPES UpdateApril 13, 20263 updates tracked since enumeration

NPPES CertifiedApril 13, 2026

✔ NPI 1821879958 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in CA · 95027684

333 W BROADWAY STE 310, Long Beach, CA 90802

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Secondary Practice Locations 2

Location 11201 Morena Blvd Ste 100San Diego, CA 92110-3814 · Phone (619) 398-0355 · Fax (619) 398-0350

Location 21061 Tierra Del Rey Ste 200Chula Vista, CA 91910-7881 · Phone (855) 501-1004

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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

Michael Deangelo Jackson Nurse Practitioner 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 ID4981101169

PECOS Enrollment IDI20251007000545

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90802 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

$96.36 typical visit price

range $62.96 – $187.60

Typical copayment $24.09 (range $15.74 – $46.90)

Most-billed visit code 99203

Established Patient

$109.96 typical visit price

range $20.84 – $153.61

Typical copayment $27.49 (range $5.21 – $38.40)

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 8

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

MEGHAN STANFORD ASW

Social Worker (Clinical)