Garrick D Jackson, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

A2147 Issued in OR

Practice address

2545 N Eldorado Ave
Klamath Falls, OR 97601-6423

Phone

(541) 883-3471

Fax

(541) 883-3524

NPI assigned

Jun 2, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lutheran Community Services Northwest 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Lutheran Community Services Northwest

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
  • NPI 1326056433

  OR

  Medicare reassignment Care Compare group NPD
• Lutheran Community Services Northwest

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Seatac, WA
  • NPI 1962628297
  Care Compare group
• Lutheran Community Services Northwest

  • Community/Behavioral Health Agency
  • McMinnville, OR
  • NPI 1255542106
  NPD
• Lutheran Community Services Northwest

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Klamath Falls, OR
  • NPI 1720105489
  NPD

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1124287594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 N ELDORADO AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976016423",
            "telephone_number": "541-883-3471",
            "fax_number": "541-883-3524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 N ELDORADO AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976016423",
            "telephone_number": "541-883-3471",
            "fax_number": "541-883-3524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "GARRICK",
        "middle_name": "D",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-02",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OR",
            "license": "A2147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "090450",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J.W. Smith, D.C., LLC
• Julia Jackman, LMT
• Robert P Jackman, MD
• Dana Sierra Jackson, PA
• Elizabeth Irene Jackson
• Kathleen Ann Jackson
• Melanie Jakobs, PHARMD
• James Alexander Jakowatz
• James M Yewchuk Chiropractic Professional Corporation
• Heidi James, CADC-R

• All providers in Klamath Falls, OR
• Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; 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.