Marian A Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.015627 Issued in IL

Practice address

125 N Ruby LN
Fairview Heights, IL 62208-1926

Phone

(618) 398-4226

Fax

(618) 398-1759

NPI assigned

Dec 19, 2012

Last updated

Dec 19, 2012By 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

Medicare fee-for-service enrollment

Enrolled in IL

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, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Promed Preferred Il 2 PLLCGroup PAC ID 3870028251, 14 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Promed Preferred Il 2 PLLC

  dba Preferred Behavioral Health Group

  • Clinical Social Worker
  • Fairview Heights, IL
  • NPI 1023855566
  Medicare reassignment Care Compare group NPD
• USA Radiology Management Solutions LLC

  • Diagnostic Radiology Physician
  • Rolla, MO
  • NPI 1689091076
  NPD (past)

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

{
    "created_epoch": "1355875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355875200000",
    "number": "1427394485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N RUBY LN",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622081926",
            "telephone_number": "618-398-4226",
            "fax_number": "618-398-1759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 N RUBY LN",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622081926",
            "telephone_number": "618-398-4226",
            "fax_number": "618-398-1759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARIAN",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-19",
        "last_updated": "2012-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.015627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• In Home Health, LLC (ProMedica Hospice (Fairview Heights))
• Maci Ingram
• Itic Support Services Group LLC (ITIC Support Services)
• Hailey E Ivy
• Diamond Jackson
• Walter J Jankowski, DMD
• Brittany Jarvis, CNP
• Olivia Drew Jarvis
• Laura J Jenkins, MS, OTR/L
• JFJ Eyecare LTD (Quantum Vision Centers)

• Clinical Social Worker in Fairview Heights, IL
• Providers in Fairview Heights, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; 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.