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PETER C. JACKSON PSYD
NPI 1942365994
Psychologist - Clinical in Madison, WI

Active since December 27, 2006Opted out of Medicare · through May 21, 2028
700 RAY O VAC DR, SUITE 220, MADISON, WI 53711(608) 276-9191(608) 276-9144 Get Directions Write a Review

NPPES record last updated: January 22, 2019. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Jan 22, 2019, Aug 30, 2017 (2 updates tracked since 2017).

About Peter C. Jackson Psyd NPPES

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

PETER C. JACKSON PSYD (NPI 1942365994) is an individual clinical provider in Madison, Wisconsin, licensed in Wisconsin (1805-057) and active in the NPI registry since December 2006. He has opted out of Medicare through May 21, 2028.

NPPES Registry Identity

NPI1942365994
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NamePETER C. JACKSONCredential: PSYD
Location Address700 RAY O VAC DR, SUITE 220Madison, WI 53711-2479
Mailing Address3330 University Ave, Ste 312Madison, WI 53705-2167 · (608) 276-9191 · Fax (608) 276-9144
Phone(608) 276-9191
Fax(608) 276-9144
Sole ProprietorYes
Enumeration DateDecember 27, 2006
Last NPPES UpdateJanuary 22, 20192 updates tracked since enumeration
✔ NPI 1942365994 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 WI · 1805-057
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.
700 RAY O VAC DR, Madison, WI 53711
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Other Identifiers 1

Medicaid39105300WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include McLaren Health Plan Community, Quartz.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Peter C. Jackson 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 May 21, 2024 through May 21, 2028.

Opt-Out Effective DateMay 21, 2024
Opt-Out In Effect ThroughMay 21, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 18

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

THORSTEN W. HORTON PHD
Marriage & Family Therapist
700 RAY O VAC DR, SUITE 220
MADISON, WI 53711
Dane County (608) 276-9191
JEAN S. BAE M.D.
Psychiatry & Neurology (Psychiatry)
700 RAY O VAC DR, SUITE 220
MADISON, WI 53711
Dane County (608) 276-9191
SARA C. LONG M.D.
Psychiatry & Neurology (Psychiatry)
700 RAY O VAC DR, SUITE 220
MADISON, WI 53711
Dane County (608) 276-9191
FAMILY THERAPY CENTER OF MADISON, INC.
Social Worker (Clinical)
700 RAY O VAC DR, SUITE 220
MADISON, WI 53711
Dane County (608) 276-9191
CAROL J. FAYNIK MA
Social Worker (Clinical)
700 RAY O VAC DR, SUITE 220
MADISON, WI 53711
Dane County (608) 276-9191
ANNE S. BEAL MSSW
Social Worker (Clinical)
700 RAY O VAC DR, SUITE 220
MADISON, WI 53711
Dane County (608) 276-9191
GAYLE M. ELLIS
Registered Nurse (Psychiatric/Mental Health)
700 RAY O VAC DR, SUITE 220
MADISON, WI 53711
Dane County (608) 276-9191
COMMUNICATION DEVELOPMENT CENTER, INC.
Speech-Language Pathologist
700 RAY O VAC DR, SUITE 200
MADISON, WI 53711
Dane County (608) 278-9161

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 Peter Jackson's NPI number?

The NPI number for Peter Jackson is 1942365994. It was assigned to this individual provider in the NPPES registry on December 27, 2006.

Where is Peter Jackson located?

Peter Jackson practices at 700 Ray O Vac Dr Suite 220, Madison, WI 53711. The listed phone number is (608) 276-9191.

What is Peter Jackson's specialty?

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

Is Peter Jackson enrolled in Medicare?

No. Peter Jackson has opted out of Medicare through May 21, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Peter Jackson accept?

Health plans from McLaren Health Plan Community and Quartz list Peter Jackson 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 Peter Jackson was last updated on January 22, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.