Andrea Marie Jackson, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3120 Issued in OR

Practice address

170 Melton Rd
Creswell, OR 97426-9453

Phone

(541) 306-6456

NPI assigned

Jun 15, 2017

Last updated

Oct 30, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 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 Psychologist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Optum Behavioral Care of Colorado PCGroup PAC ID 0941648463, 196 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ajackson166329@samhealth.direct-ci.com
• Direct secure messaging: andrea.jackson.1@28621.direct.athenahealth.com

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.

• Optum Behavioral Care of Colorado, P.C.

  dba Eugene Center for Anxiety and Stress of Oregon

  • Clinical Psychologist
  • Eugene, OR
  • NPI 1316717747
  Medicare reassignment Care Compare group NPD
• Optum Behavioral Care of Colorado, P.C.

  dba Eugene Therapy of Oregon

  • Clinical Psychologist
  • Corvallis, OR
  • NPI 1861262297
  NPD
• Optum Behavioral Care of Colorado, P.C.

  • Clinical Social Worker
  • De Pere, WI
  • NPI 1396622494
  NPD

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1194255877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 MELTON RD",
            "city": "CRESWELL",
            "state": "OR",
            "postal_code": "974269453",
            "telephone_number": "541-306-6456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 MELTON RD",
            "city": "CRESWELL",
            "state": "OR",
            "postal_code": "974269453",
            "telephone_number": "541-306-6456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "534 Pleasant View Way NW Ste 200",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "OR",
            "postal_code": "973211789",
            "country_code": "US",
            "telephone_number": "541-812-5760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANDREA",
        "middle_name": "MARIE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-15",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "3120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ajackson166329@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "534 Pleasant View Way NW Ste 200",
            "city": "Albany",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973211789",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sophie Gruszka, LMT
• Scott Andrew Hamilton
• Richard Hansen, M.D.
• Jayme Harrold, ATC
• Ted Hoggard, RPH
• Nicholas Jorgensen, PHARMD
• Joseph R. Greenwood, DMD, PC (Creswell Family Dental Clinic)
• Roopkiran Kaur, LMT, RD
• Christie Ann Kelley, LPN
• Siri Sunderta Kent

• Psychologist in Creswell, OR
• Providers in Creswell, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.