Jacob Jerry Jackson, PHD, LMHC, CADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

180 10TH St SE Ste 201
Le Mars, IA 51031-2557

Phone

(712) 546-4624

Fax

(712) 546-9395

NPI assigned

Oct 11, 2016

Last updated

Nov 6, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Plains Area Mental Health IncGroup PAC ID 5395649743, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Plains Area Mental Health, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Le Mars, IA
  • NPI 1356198147
  Medicare reassignment Care Compare group NPD
• Plains Area Mental Health, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Le Mars, IA
  • NPI 1801867734
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1003366329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 10TH ST SE",
            "city": "LE MARS",
            "state": "IA",
            "postal_code": "510312559",
            "telephone_number": "712-499-0207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 10TH ST SE STE 201",
            "city": "LE MARS",
            "state": "IA",
            "postal_code": "510312557",
            "telephone_number": "712-546-4624",
            "fax_number": "712-546-9395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JACOB",
        "middle_name": "JERRY",
        "name_prefix": "Dr.",
        "credential": "PHD, LMHC, CADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-11",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "15081",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gregory Jeneary, DDS
• Thomas Jeneary, DDS

• Mental Health Counselor in Le Mars, IA
• Providers in Le Mars, IA by specialty
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.