Jackson Newsome, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071010649 Issued in IL

Practice address

1331 N Bosworth Ave Apt 3
Chicago, IL 60642-3421

Phone

(773) 683-3200

NPI assigned

Oct 28, 2021

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 27, 2022 through Dec 27, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Forge Psychology Chicago, PLLC

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1326828278
  NPD Authorized official
• Loom Psychotherapy, PLLC

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1275398323
  NPD (past)

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

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1740944438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 N BOSWORTH AVE APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606423421",
            "telephone_number": "773-683-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 N BOSWORTH AVE APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606423421",
            "telephone_number": "773-683-3200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 W Bradley Pl Ste 210",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606184716",
            "country_code": "US",
            "telephone_number": "773-683-3200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEWSOME",
        "first_name": "JACKSON",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-28",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlotte D. Newsom, LCPC
• Destiny Newsom
• Newsome Speech and Language Therapy P. C.
• Andre D Newsome, MS, MS, MHS, CADC
• Anthony L Newsome, LMT
• Kasandra Newsome, LSW
• Marcia Kay Newsome, M.ED
• Natanya Newsome
• Bradford Newton, OD
• Colleen Marie Newton

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.