Regina Jackson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

88001003A Issued in IN

Practice address

3103 Blackiston Mill Rd
New Albany, IN 47150-9536

Phone

(812) 590-7160

NPI assigned

Jan 31, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Auxilium Psychological Services LLCGroup PAC ID 4082057823, 3 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 and National Provider Directory roles.

• Auxilium Psychological Services, LLC

  • Psychologist
  • New Albany, IN
  • NPI 1649787565
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1811528565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 BLACKISTON MILL RD",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "471509536",
            "telephone_number": "812-590-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3103 BLACKISTON MILL RD",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "471509536",
            "telephone_number": "812-590-7160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "REGINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-31",
        "last_updated": "2023-11-27",
        "certification_date": "2020-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "88001003A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@auxiliumpsychology.com",
            "affiliation": "Y",
            "affiliationName": "Auxilium Psychological Services, LLC",
            "address_1": "3103 Blackiston Mill Rd",
            "city": "New Albany",
            "state": "IN",
            "country_code": "US",
            "postal_code": "471509536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Derrick Jack, LCSW
• Kimberly Latrice Jackson-Grundy, PHARMD
• Hannah Jordan Jackson, DMD
• Jessica Jackson, DPM
• Nicole Jackson
• Jacque Deshay Young, PLLC
• Cara Harris James, D.M.D
• Dawne Michelle James, LCSW
• Kelsey Lynn James
• Sophia Jameson, MSN, FNP-C

• Mental Health Counselor in New Albany, IN
• Providers in New Albany, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.