Anthony I Jackson, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

73831 Issued in CA

Practice address

2390 E Orangewood Ave Ste 300
Anaheim, CA 92806-6138

Phone

(714) 543-4333

Fax

(714) 543-4398

NPI assigned

Sep 17, 2012

Sex

Male

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 CA

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

Harbor Community Clinic IncGroup PAC ID 8022166826, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Harbor Community Clinic Inc.

  • Federally Qualified Health Center (FQHC)
  • San Pedro, CA
  • NPI 1467490425
  Medicare reassignment Care Compare group NPD
• Harbor Community Clinic Inc

  • Pediatrics Physician
  • San Pedro, CA
  • NPI 1831739614
  NPD
• The Priority Center Ending the Generational Cycle of Trauma Inc

  • Mental Health Counselor
  • Santa Ana, CA
  • NPI 1356474878
  NPD (past)

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

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1669722708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2390 E ORANGEWOOD AVE STE 300",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928066138",
            "telephone_number": "714-543-4398",
            "fax_number": "714-543-4398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2390 E ORANGEWOOD AVE STE 300",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928066138",
            "telephone_number": "714-543-4333",
            "fax_number": "714-543-4398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANTHONY",
        "middle_name": "I",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-17",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "73831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J&E Supplies & Services LLC
• Jay T. Jablow, MD
• Janice Jabonero
• Veena Theresa Sandejas Jacildo, PTA
• Jack Gutman DO Professional Corp
• Gabrielle C Etchegaray Jackson, DPT
• Jaye Jackson
• Jennifer Joyce Jackson, BA
• Lance Jackson
• David Jim Jacob, D.C.

• Clinical Social Worker in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; 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.