Chanell Shannon Jackson, NMW, WHNP is a medicare enrolled "Midwife" in Culver City, California. She graduated from nursing school in 2018 and has 8 years of diverse experience with area of expertise as Certified Nurse Midwife (cnm). She is a member of the group practice Southern California Permanente Medical Group and her current practice location is
5883 1/2 Doverwood Dr, Culver City, California. You can reach out to her office (for appointments etc.) via phone at
(310) 848-7736.
Chanell Shannon Jackson is licensed to practice in California (license number 236061) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1356011597.
Provider's Profile
| Full Name | Chanell Shannon Jackson |
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| Gender | Female |
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| Speciality | Certified Nurse Midwife (cnm) |
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| Experience | 8 Years |
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| Location | 5883 1/2 Doverwood Dr, Culver City, California |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Chanell Shannon Jackson graduated from nursing school in 2018
NPI Data:
- NPI Number: 1356011597
- Provider Enumeration Date: 09/19/2021
- Last Update Date: 03/30/2022
Medicare PECOS Information:
- PECOS PAC ID: 7911393723
- Enrollment ID: I20220404002229
Medical Identifiers
Medical identifiers for Chanell Shannon Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1356011597 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LW0102X | Nurse Practitioner - Women's Health | 236061 (California) | Secondary |
| 176B00000X | Midwife | 236061 (California) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Southern California Permanente Medical Group | 6002729175 | 11244 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Chanell Shannon Jackson allows following entities to bill medicare on her behalf.
| Entity Name | Southern California Permanente Medical Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1316979834
PECOS PAC ID: 6002729175
Enrollment ID: O20040126000823 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Chanell Shannon Jackson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Chanell Shannon Jackson, NMW, WHNP
5883 1/2 Doverwood Dr,
Culver City, CA 90230-7203
Ph: (310) 848-7736 | Chanell Shannon Jackson, NMW, WHNP
5883 1/2 Doverwood Dr,
Culver City, CA 90230-7203
Ph: (310) 848-7736 |
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