Kay Ellen Jackson, PH. D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

012747-1 Issued in NY

Practice address

214 W 29TH St
Suite 703
New York, NY 10001-5203

Phone

(212) 564-7631

NPI assigned

Mar 12, 2008

Last updated

Feb 1, 2017By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Shiloh Consulting LLCGroup PAC ID 2062675887, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shiloh Consulting LLC

  • Forensic Psychologist
  • New York, NY
  • NPI 1659500577
  Medicare reassignment Care Compare group NPD Authorized official
• Shiloh Psychological Consulting

  • Substance Use Disorder Rehabilitation Clinic/Center
  • New York, NY
  • NPI 1346718889
  NPD (past)

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

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485907200000",
    "number": "1417127945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 W 29TH ST",
            "address_2": "SUITE 703",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100015203",
            "telephone_number": "212-564-7631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 W 29TH ST",
            "address_2": "SUITE 703",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100015203",
            "telephone_number": "212-564-7631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KAY",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "PH. D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-12",
        "last_updated": "2017-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "012747-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1417127945",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Jackson, M.D.
• John James Jackson, LMSW
• Jonathan M Jackson, PHD
• Julie Jackson, M.S, CCC-SLP
• Kaitlyn Hansen Jackson, MSN, CPNP-PC, RN
• Keyanna Jackson, MD
• Krystal Jackson
• Lois Ann Jackson, D.D.S.
• Lorraine Jackson, NURSE PRACTITIONER
• Lucille Jackson, LCSW

• Psychologist in New York, NY
• Providers in New York, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2017; 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.