David Jackson, LICSW
Individual provider Active NPI Clinical Social Worker · Pine City, MN
NPI 1548972425 · NPPES record last updated Dec 22, 2022
Key facts
- NPI
- 1548972425
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 21551 (MN)
- Practice address
- 220 Railroad St SE
Pine City, MN 55063-1540 - Phone
- (320) 629-7600
- NPI assigned
- Dec 22, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Therapeutic Services Agency Inc
Practice addresses (Care Compare)
705 Hillside Ave SE
Pine City, MN 55063-1466
Phone (320) 629-7600
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- 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 |
|---|---|---|---|---|
| I20230606003501 | MN | Practitioner - Clinical Social Worker | 4385001361 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapeutic Services Agency Inc | Current |
Accepting new patients |
Locations
705 Hillside Ave SW
Pine City, MN 55063
220 Railroad St SE
Pine City, MN 55063
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 21551 | MN | Yes |
Addresses
Primary practice location
220 Railroad St SE
Pine City, MN 55063-1540
Mailing address
220 Railroad St SE
Pine City, MN 55063-1540
Phone (320) 629-7600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21551 | Medicaid | MN |
Other providers in Pine City, MN
- Tracie Houle
- Nicole Cecelia Hubbs
- Annette Veneva Huff
- Hultman Lake Enterprises
- Ind School District 578
- Lainie K Janke
- Jeff'S Outdoor Services
- Jewett Lake Enterprises
- Erik Robert Johnson
- Jami Johnson
All providers in Pine City, MN · Clinical Social Worker in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2022. 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.