Becky A Jacks

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R232693 Issued in MD

Practice address

11100 Billingsley Rd
Waldorf, MD 20602-3400

Phone

(301) 357-4199

NPI assigned

Jul 27, 2023

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 DC

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kirstin'S Haven, IncGroup PAC ID 2264778778, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Kirstin'S Haven, Inc

  • Case Management Agency
  • Camp Springs, MD
  • NPI 1225585136

  DC

  Medicare reassignment Care Compare group
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  DC, Single Specialty

  Medicare reassignment NPD
• Legacy Behavioral Health Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Waldorf, MD
  • NPI 1376474783
  NPD Authorized official

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

{
    "created_epoch": "1690416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1245911767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11100 BILLINGSLEY RD",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023400",
            "telephone_number": "301-357-4199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 BILLINGSLEY RD",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023400",
            "telephone_number": "301-357-4199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKS",
        "first_name": "BECKY",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-27",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R232693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ingrid Ives-Pinkney, NCC, LCPC
• Grace Dhikusooka Ivumbi
• Najmeh Izadpanah, M.D.
• Ramez S.F. Jabaji, M.D.
• Rebecca Jablon
• Jackson Family Medicine, LLC
• Ruth Clarie Jackson-Hayes, M.A., L.P.C.
• Angela Jackson
• Brendalan Jackson, LCSW
• Crystal I Jackson, LGSW-G

• Psychiatric/Mental Health Nurse Practitioner in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.