Amanda Marie Jackson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

11782-C Issued in NV

Practice address

24 Goldleaf Falls Ave
North Las Vegas, NV 89031-2957

Phone

(202) 909-5016

NPI assigned

Oct 6, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Amanda Maire Jackson Former name

Medicare fee-for-service enrollment

Enrolled in NV

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Geiss Med Nevada PCGroup PAC ID 8921400599, 16 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.

• Geiss Med Nevada PC

  • Family Medicine Physician
  • Orange, CA
  • NPI 1033793963

  NV

  Medicare reassignment Care Compare group NPD
• J M Geiss DO Apc

  • Family Medicine Physician
  • Santa Ana, CA
  • NPI 1063825289

  NV

  Medicare reassignment NPD
• Success Counseling Services North Dba Success Insite

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bossier City, LA
  • NPI 1699780122
  NPD (past)

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

{
    "created_epoch": "1444089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1376913111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 GOLDLEAF FALLS AVE",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890312957",
            "telephone_number": "202-909-5016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 GOLDLEAF FALLS AVE",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890312957",
            "telephone_number": "202-909-5016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-06",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "11782-C",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "JACKSON",
            "middle_name": "MAIRE",
            "prefix": "MS.",
            "credential": "AMANDA MARIE SELLARS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bricia Tomasa Jack
• Tanya Sheri Jackson Renter
• Ariana Rael Jackson-Curry, RDN
• Angele Jackson-Grayson
• Aaron Scott Jackson
• Antonio Jackson
• Ashley Jackson, RN
• Bianca Jackson
• Brenda Jackson
• Crystal Jackson

• Clinical Social Worker in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.