Richard Allen Jackson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

23282 Issued in MN

Practice address

201 W Laurel St
Brainerd, MN 56401-3902

Phone

(218) 454-3844

Fax

(218) 454-3844

NPI assigned

Oct 25, 2016

Last updated

Apr 12, 2018By the provider in NPPES

Sex

Male

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 MN

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, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The TherapistGroup PAC ID 7618383951, 6 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.

• The Therapist

  dba The Therapist PLC

  • Professional Counselor
  • Brainerd, MN
  • NPI 1093263113
  Medicare reassignment Care Compare group NPD
• Northern Pines Mental Health Center, Inc.

  • Community/Behavioral Health Agency
  • Brainerd, MN
  • NPI 1225168602
  NPD (past)

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

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523491200000",
    "number": "1629520770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 MAPLE ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W LAUREL ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013902",
            "telephone_number": "218-454-3844",
            "fax_number": "218-454-3844"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 W Laurel St",
            "address_purpose": "LOCATION",
            "city": "Brainerd",
            "state": "MN",
            "postal_code": "564013902",
            "country_code": "US",
            "telephone_number": "218-454-3844",
            "fax_number": "218-454-3844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RICHARD",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-25",
        "last_updated": "2018-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "23282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sindhura Inkollu, MD
• Inmotion Physical Therapy LLC (InMotion Physical Therapy and Fitness)
• Inmotion Physical Therapy LLC
• Mariah M Isola, OTR/L
• Denise Bowen Iverson, MS LP
• Andrew Miller Jacobson, M.D.
• Mark A. James, M.D.
• Andrew Michael Janke, AUD
• Nathan Anton Jarnot, DDS
• Jennifer Owens Therapy Services, LLC

• Clinical Social Worker in Brainerd, MN
• Providers in Brainerd, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; 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.