Alissa Nicole Jackson, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I0900346 Issued in OH

Practice address

929 Harrison Ave Ste 304
Columbus, OH 43215-1346

Phone

(614) 940-4868

NPI assigned

Jan 4, 2021

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 OH

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, 2002

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alissa.jackson.1@26020.direct.athenahealth.com

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.

• Oh Independent Medical Group LLC

  • Family Medicine Physician
  • Columbus, OH
  • NPI 1497482111
  Medicare reassignment NPD
• Enliven Resources, LLC

  • Clinical Social Worker
  • Columbus, OH
  • NPI 1376820209
  NPD
• Oh Independent Medical Group LLC

  • Durable Medical Equipment & Medical Supplies
  • Circleville, OH
  • NPI 1114753431
  NPD

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

{
    "created_epoch": "1609718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1891383006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 CORNICE CT",
            "city": "GALENA",
            "state": "OH",
            "postal_code": "430219076",
            "telephone_number": "614-403-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 HARRISON AVE STE 304",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432151346",
            "telephone_number": "614-940-4868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALISSA",
        "middle_name": "NICOLE",
        "credential": "LISW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-04",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I0900346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Lynn Jackson Love, DOULA
• Yolundra Rochelle Jackson-Christian, QMHS; LMT
• Tammie Cherrelle Jackson-Malone, QBHS
• Achaundae Jackson
• Aleasha Dashawynna Jackson
• Alvin Glen Jackson, LPC
• Amanda Jackson
• Amber Nicole Jameka Jackson
• Angela Jackson
• Angelina C Jackson

• Clinical Social Worker in Columbus, OH
• Providers in Columbus, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; 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.