Jackson Tea, MSN, PMHNP-BC in Anaheim, CA - Medicare Nurse Practitioner

Jackson Tea, MSN, PMHNP-BC is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Anaheim, California. His current practice location is 1720 W Ball Rd Ste 4c, Anaheim, California. You can reach out to his office (for appointments etc.) via phone at (714) 683-1472.

Jackson Tea is licensed to practice in California (license number 95033550) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1477365997.

Contact Information

	Jackson Tea, MSN, PMHNP-BC
	1720 W Ball Rd Ste 4c, Anaheim, CA 92804-5591
	(714) 683-1472
	(714) 683-1473

Map and Direction

Provider's Profile

Full Name	Jackson Tea
Gender	Male
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	1720 W Ball Rd Ste 4c, Anaheim, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1477365997
Provider Enumeration Date: 01/22/2025
Last Update Date: 04/15/2025

Medicare PECOS Information:

PECOS PAC ID: 5597295139
Enrollment ID: I20250219002194

Medical Identifiers

Medical identifiers for Jackson Tea such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1477365997	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	95033550 (California)	Primary

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. Jackson Tea allows following entities to bill medicare on his behalf.

Entity Name	Medard Sison Np, A Professional Nursing Corporation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1528693579 PECOS PAC ID: 5294151635 Enrollment ID: O20200817002415

Entity Name	Bje Esterman P C
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1780435628 PECOS PAC ID: 2062951205 Enrollment ID: O20240830003581

Entity Name	Renewed Community Mental Health
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1912736026 PECOS PAC ID: 0244760882 Enrollment ID: O20250211003349

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. Jackson Tea 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
Jackson Tea, MSN, PMHNP-BC 734 Lantana St, La Verne, CA 91750-5727 Ph: (626) 429-0088	Jackson Tea, MSN, PMHNP-BC 1720 W Ball Rd Ste 4c, Anaheim, CA 92804-5591 Ph: (714) 683-1472

Reviews and Comments

Nurse Practitioner Nurses in Anaheim, CA

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Mr. William George Woods, NURSE PRACTITIONER Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1211 W La Palma Ave Ste 207, Anaheim, CA 92801 Phone: 714-772-8282 Fax: 714-772-6493
Mariam Alhakim, CPNP-PC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1110 W La Palma Ave, Anaheim, CA 92801 Phone: 714-991-3180
Jovani Rioja, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3440 E La Palma Ave, Anaheim, CA 92806 Phone: 714-423-4168
Gayatri Subedi, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1771 W Romneya Dr. Ste C, Anaheim, CA 98201 Phone: 714-758-0403

Jackson Tea, MSN, PMHNP-BC - Medicare Nurse Practitioner in Anaheim, CA