MS. SAMALA JACKSON CRNP
NPI 1184362600
Nurse Practitioner - Gerontology in Philadelphia, PA

NPI Status: Active since May 24, 2022

Contact Information

3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA
ZIP 19134
Phone: (215) 444-7472
Fax: (215) 979-6726

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  • Individual
  • Female
  • Years of Experience 9
  • Nurse Practitioner
  • Gerontology
  • Accepts Insurance
  • Accepts Medicare Approved Payment
  • PECOS Enrolled

About SAMALA JACKSON

This page provides the complete NPI Profile along with additional information for Samala Jackson, a provider established in Philadelphia, Pennsylvania with a medical specialization in Nurse Practitioner, focusing in gerontology and more than 9 years of experience. The healthcare provider is registered in the NPI registry with number 1184362600 assigned on May 2022. The practitioner's primary taxonomy code is 363LG0600X with license number SP018935 (PA). The provider is registered as an individual and her NPI record was last updated April 2025.

NPI
1184362600
Provider Name
MS. SAMALA JACKSON CRNP
Gender
Female
Entity Type
Individual
Location Address
3621 ARAMINGO AVE STE 5C PHILADELPHIA, PA 19134
Location Phone
(215) 444-7472
Location Fax
(215) 979-6726
Mailing Address
PO BOX 746722 ATLANTA, GA 30374
Mailing Phone
(773) 352-1515
Medical School Name
OTHER
Graduation Year
2017
Is Sole Proprietor?
Yes
Enumeration Date
05-24-2022
Last Update Date
04-28-2025
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A nurse practitioner (NP) like Samala Jackson is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

Location Map

Secondary Locations

  • 9200 Bustleton Ave Apt 1705
    Philadelphia, PA 19115
    (215) 760-6386

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Nurse Practitioner Gerontology

Taxonomy Code
363LG0600X
Type
Physician Assistants & Advanced Practice Nursing Providers
License No.
SP018935
License State
PA

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Choice Bronze HSA - HMO
  • Choice Bronze HSA + Vision + Adult Dental - HMO
  • Clear Gold - HMO
  • Clear Gold + Vision + Adult Dental - HMO
  • Clear Silver - HMO
  • Complete Gold - HMO
  • Complete Gold + Vision + Adult Dental - HMO
  • Complete Silver - HMO
  • Complete Silver + Vision + Adult Dental - HMO
  • Elite Bronze - HMO
  • Elite Bronze + Vision + Adult Dental - HMO
  • Elite Silver - HMO
  • Elite Silver + Vision + Adult Dental - HMO
  • Everyday Bronze - HMO
  • Everyday Bronze + Vision + Adult Dental - HMO
  • Everyday Gold - HMO
  • Everyday Gold + Vision + Adult Dental - HMO
  • Focused Silver - HMO
  • Focused Silver + Vision + Adult Dental - HMO
  • Standard Expanded Bronze - HMO
  • Clear Gold - EPO
  • Clear Gold + Vision + Adult Dental - EPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Elite Silver - EPO
  • Elite Silver + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Premier Bronze HSA - EPO
  • Premier Bronze HSA + Vision + Adult Dental - EPO
  • Standard Expanded Bronze - EPO
  • Standard Expanded Bronze + Vision + Adult Dental - EPO
  • Standard Gold - EPO
  • Standard Gold + Vision + Adult Dental - EPO
  • Standard Silver - EPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Samala Jackson is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Samala Jackson is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 6800277153

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20220718001252

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Administration of influenza virus vaccine

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

This service was performed 19 times for 19 patients

Established patient home visit, typically 40 minutes

An established patient home visit is a medical appointment conducted at your home, typically lasting around 40 minutes. This service is ideal for patients who may find it difficult to travel to a healthcare facility. During this visit, a healthcare professional will evaluate your health status, manage your care, and answer any health-related questions you may have.

This service was performed 123 times for 67 patients

Influenza vaccine, quadrivalent derived from cell cultures

The quadrivalent influenza vaccine, derived from cell cultures, is a flu shot that protects against four different flu viruses. It's made in labs using cell cultures instead of eggs, making it a good option for those with egg allergies. It's a crucial tool in preventing the flu.

This service was performed 19 times for 19 patients

Physician Visit Costs



The typical physician office visit costs for Medicare beneficiaries in this area are: $23.17 for a new patient copayment and $26.3 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 19134 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $92.69
  • Minimum New Patient Price $59.88
  • Maximum New Patient Price $180.99
  • Average New Patient Copayment $23.17
  • Minimum New Patient Copayment $14.97
  • Maximum New Patient Copayment $45.24

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $105.21
  • Minimum Established Patient Price $19.3
  • Maximum Established Patient Price $147.29
  • Average Established Patient Copayment $26.3
  • Minimum Established Patient Copayment $4.82
  • Maximum Established Patient Copayment $36.82

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Reviews for MS. SAMALA JACKSON CRNP

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1184362600
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2116466460
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 1 + 6 + 4 + 6 + 6 + 4 + 6 + 0 + 24 = 60
Step 3: because the number obtained in step 2 ends in zero, the check digit is zero.
0

The NPI number 1184362600 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 19 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1982242822MS. DIANE NICHOLE JONES APRN, FNP-C
Individual
Nurse Practitioner (Family)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1831537836 ANNA NJARLANGATTIL THOMAS M.D.
Individual
Internal Medicine (Hospice and Palliative Medicine)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1962829267 KIMBERLY STEAR
Individual
Nurse Practitioner (Family)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1689056343 TANYA TREWICK - RYANS CRNP
Individual
Nurse Practitioner (Family)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1992465736 ARGINE CLAIRE GUAR CRNP
Individual
Nurse Practitioner (Family)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1699443481MRS. HEATHER LAWSON APN
Individual
Nurse Practitioner (Family)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1275899767MRS. LUNA METAYER BELIZAIRE CRNP
Individual
Nurse Practitioner (Family)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1063972552 LAUREN LACEY HUGHES MD
Individual
Internal Medicine3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1134497811 LESLIE BURTON CRNP
Individual
Nurse Practitioner (Family)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1134610843MS. ALKANEASE GARRETT M.ED, LSW
Individual
Social Worker3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1154781946 CHRISTINE WEGMANN CRNP
Individual
Nurse Practitioner (Adult Health)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1275955015MS. DAPHNE TONIE ALEXIS CRNP
Individual
Nurse Practitioner (Family)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1366431207 GERALD FRANCIS DRISCOLL JR. CRNP
Individual
Nurse Practitioner (Gerontology)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1417128075 RISA COHEN LCSW
Individual
Social Worker (Clinical)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1427323195MRS. JENNIFER LYNN CRUZ FNP-BC
Individual
Nurse Practitioner (Family)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1477708287MS. ALLISON DENISE GIBBS MSW, LCSW
Individual
Social Worker (Clinical)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1528531258 RACHEL HILDEBRAND NP
Individual
Nurse Practitioner (Gerontology)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1548555196 STACEY L. BISHOP CRNP
Individual
Nurse Practitioner (Family)3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472
1619728722MR. FREDERICK WILLIAM PENCE LSW
Individual
Social Worker3621 ARAMINGO AVE STE 5C
PHILADELPHIA, PA 19134
(215) 444-7472

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1184362600, enumerated in the NPI registry as an "individual" on May 24, 2022

The provider is located at 3621 Aramingo Ave Ste 5c Philadelphia, Pa 19134 and the phone number is (215) 444-7472

The provider's speciality is Nurse Practitioner with taxonomy code 363LG0600X with a focus in Gerontology

The provider has more than 9 years of experience.

The provider might be accepting Accepts: Ambetter Health and Ambetter Health of Delaware. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

Medicare beneficiaries should expect a typical cost of $92.69 with an average copayment of $23.17 for new patient appointments. Established patients should expect a typical charge of $105.21 and an average copayment of 26.3. Please review your insurance plan or contact the provider directly to determine your specific costs.

The most common procedures or services performed by this practitioner are: Administration of influenza virus vaccine, Established patient home visit, typically 40 minutes and Influenza vaccine, quadrivalent derived from cell cultures.

This NPI record was last updated on May 24, 2022. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.