Andrea Marie Jackson, PHD
Individual provider Active NPI Psychologist · Creswell, OR
NPI 1194255877 · NPPES record last updated Oct 30, 2024
Key facts
- NPI
- 1194255877
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 3120 (OR)
- Practice address
- 170 Melton Rd
Creswell, OR 97426-9453 - Phone
- (541) 306-6456
- NPI assigned
- Jun 15, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 14
Medicare Care Compare profile
- 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 PC
Practice addresses (Care Compare)
940 Willamette St
Suite 230
Eugene, OR 97401-3129
Phone (541) 357-9761
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190905003099 | OR | Practitioner - Clinical Psychologist | 7719216431 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optum Behavioral Care of Colorado, P.C. | Current |
Accepting new patients | |
| Optum Behavioral Care of Colorado, P.C. | Current |
Accepting new patients | |
| Optum Behavioral Care of Colorado, P.C. | Current | Accepting new patients |
Locations
940 Willamette St
Ste 230
Eugene, OR 97401
Phone (541) 354-9764
399 E 10th Ave
Eugene, OR 97401
Phone (541) 868-2004
Interoperability endpoints
- andrea.jackson.1@28621.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3120 | OR | Yes |
Addresses
Primary practice location
170 Melton Rd
Creswell, OR 97426-9453
Mailing address
170 Melton Rd
Creswell, OR 97426-9453
Phone (541) 306-6456
Other practice location 1
534 Pleasant View Way NW Ste 200
Albany, OR 97321-1789
Phone (541) 812-5760
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ajackson166329@samhealth.direct-ci.com |
Other providers in Creswell, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.