Jan Meredith Jackson, M.A.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

160 Beechwood Ave
Pawtucket, RI 02860-5402

Phone

(401) 667-6720

NPI assigned

Feb 5, 2018

Sex

Female

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 RI

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

Mental Health Counselor

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arrow Behavioral HealthGroup PAC ID 7618319872, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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 and National Provider Directory roles.

• Arrow Behavioral Health

  • Mental Health Counselor
  • Warwick, RI
  • NPI 1053990655
  Medicare reassignment Care Compare group NPD
• Gateway Healthcare Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pawtucket, RI
  • NPI 1821078932
  NPD (past)
• Gateway Healthcare, Inc

  • Clinical Social Worker
  • Pawtucket, RI
  • NPI 1154351211
  NPD (past)

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

{
    "created_epoch": "1517788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517788800000",
    "number": "1790284792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "249 ROOSEVELT AVE UNIT 205",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028602134",
            "telephone_number": "401-724-8400",
            "fax_number": "401-305-3874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 BEECHWOOD AVE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028605402",
            "telephone_number": "401-667-6720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JAN",
        "middle_name": "MEREDITH",
        "name_prefix": "Miss",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-05",
        "last_updated": "2018-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorrie Ivey
• Ivoha Health & Consulting, LLC
• Barbara Jablow, MD
• Carissa May Jackson, LCSW
• Jamie Jackson, BEYOND HS
• Jerilyn Ann Jackson, R.D.
• Tyla Jackson
• Mohammed Jamali, PT
• Aimee R James, CNM, WHNP-BC
• Elizabeth James, MASTERS

• Mental Health Counselor in Pawtucket, RI
• Providers in Pawtucket, RI by specialty
• Mental Health Counselor in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.