DR. COLLEEN ELIZABETH JACKSON PHD
NPI 1952765661
Clinical Neuropsychologist in Boston, MA
NPI Status: Active since April 08, 2016
Contact Information
185 DEVONSHIRE STREET
SUITE 902
BOSTON, MA
ZIP 02110
Phone: (617) 362-0588
- Individual
- Female
- Clinical Neuropsychologist
- Opted-Out Medicare
About COLLEEN JACKSON
This page provides the complete NPI Profile along with additional information for Colleen Jackson, a provider established in Boston, Massachusetts with a medical specialization in Clinical Neuropsychologist. The healthcare provider is registered in the NPI registry with number 1952765661 assigned on April 2016. The practitioner's primary taxonomy code is 103G00000X with license number 11211 (MA). The provider is registered as an individual and her NPI record was last updated 4 years ago.
- NPI
- 1952765661
- Provider Name
- DR. COLLEEN ELIZABETH JACKSON PHD
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 185 DEVONSHIRE STREET SUITE 902 BOSTON, MA 02110
- Location Phone
- (617) 362-0588
- Mailing Address
- 185 DEVONSHIRE STREET SUITE 902 BOSTON, MA 02110
- Mailing Phone
- (617) 362-0588
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 04-08-2016
- Last Update Date
- 08-31-2022
- Code Navigator
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Colleen Jackson opted out of Medicare effective on 03-03-2022 until 03-03-2026. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare and cannot order and refer services to other healthcare providers.
Location Map
Secondary Locations
- 150 S Huntington Ave Boston VA Medical Center (116B)
Boston, MA 02130
(857) 364-2081
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinical Neuropsychologist
- Taxonomy Code
- 103G00000X
- Type
- Behavioral Health & Social Service Providers
- License No.
- 11211
- License State
- MA
- Taxonomy Description
- A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | PS01471 (RI) |
| 2 | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | PS01471 (RI) |
| 3 | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | PS01471 (RI) |
Medicare Participation & PECOS Enrollment Status
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 03-03-2022
Opt-Out End Date: 03-03-2026
Eligible to Order and Refer? No
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1952765661, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 59. The final step is to find the difference between that total and the next multiple of ten (60 - 59 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 59 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1952765661, enumerated as an "individual" on April 08, 2016.
The provider is located at 185 DEVONSHIRE STREET SUITE 902 BOSTON, MA 02110 and the phone number is (617) 362-0588.
Clinical Neuropsychologist with taxonomy code 103G00000X.
