Samala Jackson, CRNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

SP018935 Issued in PA

Practice address

1055 Westlakes Dr Ste 3152
Berwyn, PA 19312-2410

Phone

(215) 346-6050

Fax

(215) 220-3562

NPI assigned

May 24, 2022

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Vpa PCGroup PAC ID 9234041948, 181 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Home Health Home health agency, Newtown, PA, CCN 397015
• Bayada Home Health Care, Inc. Home health agency, Jamison, PA, CCN 397791
• Accentcare Health of Pennsylvania Home health agency, Bristol, PA, CCN 397472
• Jefferson Health at Home by Bayada Home health agency, Philadelphia, PA, CCN 397643
• Holy Redeemer Home Care-PA Home health agency, Philadelphia, PA, CCN 397104

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samala.jackson@pennmedicine.upenn.edu

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.

• Vpa PC

  • Family Medicine Physician
  • Boardman, OH
  • NPI 1609942762

  PA

  Medicare reassignment Care Compare group NPD
• Osh - PA Physicians Group, PC

  • Primary Care Clinic/Center
  • Philadelphia, PA
  • NPI 1811405533
  Medicare reassignment NPD
• Primary Homecare, LLC

  • Primary Care Nurse Practitioner
  • Elkins Park, PA
  • NPI 1629023593

  Gerontology

  Medicare reassignment NPD
• Vpa PC

  • Family Medicine Physician
  • King of Prussia, PA
  • NPI 1386256881
  NPD
• Vpa PC

  • Family Medicine Physician
  • Brentwood, TN
  • NPI 1578363362
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Holy Redeemer Health System

  • Home Health Agency
  • Philadelphia, PA
  • NPI 1972577617
  Care Compare affiliation Name & address match
• Bayada Home Health Care, Inc.

  • Home Health Agency
  • Blue Bell, PA
  • NPI 1245323351
  Care Compare affiliation
• Bayada Home Health Care, Inc.

  • Home Health Agency
  • Hatboro, PA
  • NPI 1316387798
  Care Compare affiliation
• Bayada Home Health Care, Inc.

  • Home Health Agency
  • Bethlehem, PA
  • NPI 1477713519
  Care Compare affiliation
• Bayada Home Health Care, Inc.

  • Home Health Agency
  • Jamison, PA
  • NPI 1649217092
  Care Compare affiliation
• Bayada Home Health Care, Inc.

  • Home Health Agency
  • Newtown, PA
  • NPI 1801837976
  Care Compare affiliation
• Jeffhome PA, LLC.

  • Home Health Agency
  • Philadelphia, PA
  • NPI 1700533049
  Care Compare affiliation
• Mercy Home Health

  • Home Health Agency
  • Newtown, PA
  • NPI 1467412296
  Care Compare affiliation
• Southeastern Health Services of Pennsylvania, LLC

  • Home Health Agency
  • Bristol, PA
  • NPI 1518901610
  Care Compare affiliation

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

{
    "created_epoch": "1653350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1184362600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40412",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049151255",
            "telephone_number": "248-824-6500",
            "fax_number": "855-618-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 WESTLAKES DR STE 3152",
            "city": "BERWYN",
            "state": "PA",
            "postal_code": "193122410",
            "telephone_number": "215-346-6050",
            "fax_number": "215-220-3562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9200 Bustleton Ave Apt 1705",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191154230",
            "country_code": "US",
            "telephone_number": "215-760-6386",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3621 Aramingo Ave Ste 5C",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191344607",
            "country_code": "US",
            "telephone_number": "215-444-7472",
            "fax_number": "215-979-6726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SAMALA",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-24",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SP018935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Samala.Jackson@pennmedicine.UPenn.edu",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "150 Monument Rd Ste 300",
            "city": "Bala Cynwyd",
            "state": "PA",
            "country_code": "US",
            "postal_code": "190041725",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Samala.jackson@pennmedicine.UPenn.edu",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "150 Monument Rd Ste 300",
            "city": "Bala Cynwyd",
            "state": "PA",
            "country_code": "US",
            "postal_code": "190041725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Impactful Human Services LLC
• Impactful Human Services LLC
• Innovative Diagnostic Solutions LLC
• Innovative Senior Home Care
• Chante Monique Jackson, LPC
• Madisen Taylor Jastremski, PT, DPT
• Justin Jenkins, LCSW
• JMB Therapy Services LLC
• JMJ Healthcare Incorporated
• Jordan Jonas, MS, LAT, ATC

• Gerontology Nurse Practitioner in Berwyn, PA
• Providers in Berwyn, PA by specialty
• Gerontology Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; 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.