Brandi G King-Jackson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

182 SW Academy St
Dallas, OR 97338-1996

Phone

(503) 623-9289

NPI assigned

Apr 10, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Clinical Social Worker

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Yamhill CountyGroup PAC ID 3274421169, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Yamhill County

  • Community/Behavioral Health Agency
  • McMinnville, OR
  • NPI 1891821500
  Medicare reassignment Care Compare group NPD
• Yamhill County

  dba Yamhill County Chemical Dependency Program

  • Community/Behavioral Health Agency
  • McMinnville, OR
  • NPI 1972669539
  NPD

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1023541703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "182 SW ACADEMY ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381996",
            "telephone_number": "503-623-9289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 SW ACADEMY ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381996",
            "telephone_number": "503-623-9289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING-JACKSON",
        "first_name": "BRANDI",
        "middle_name": "G",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-10",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lea Camille Domingo Keenantasker, DPT
• Ellen Keithley-Garcia
• Charles M Kennedy, NCAC II
• Rosemary Kennedy, BS ELEMENTARY ED
• Wren Elliot Jane Kennedy
• Joseph Edward King IV, PHARM-D
• Michael Joseph Kirkland, D.C.
• Bethany Patricia Kleiber, DPT
• Susan Marie Klein
• Gary Knowles, OD

• Clinical Social Worker in Dallas, OR
• Providers in Dallas, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.