Ms Samala Jackson, CRNP - Medicare Nurse Practitioner in Berwyn, PA

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Ms Samala Jackson, CRNP is a medicare enrolled "Nurse Practitioner - Gerontology" in Berwyn, Pennsylvania. Her current practice location is 1055 Westlakes Dr Ste 3152, Berwyn, Pennsylvania. You can reach out to her office (for appointments etc.) via phone at (215) 346-6050.

Ms Samala Jackson is licensed to practice in Pennsylvania (license number SP018935) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1184362600.

Contact Information

Ms Samala Jackson, CRNP
1055 Westlakes Dr Ste 3152,
Berwyn, PA 19312-2410
(215) 346-6050
(215) 220-3562

Map and Direction




Provider's Profile

Full NameMs Samala Jackson
GenderFemale
SpecialityNurse Practitioner - Gerontology
Location1055 Westlakes Dr Ste 3152, Berwyn, Pennsylvania
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1184362600
  • Provider Enumeration Date: 05/24/2022
  • Last Update Date: 10/24/2025
  Medicare PECOS Information:
  • PECOS PAC ID: 6800277153
  • Enrollment ID: I20220718001252

Medical Identifiers

Medical identifiers for Ms Samala Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1184362600NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LG0600XNurse Practitioner - Gerontology SP018935 (Pennsylvania)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. Ms Samala Jackson allows following entities to bill medicare on her behalf.
Entity NamePrimary Homecare Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1629023593
PECOS PAC ID: 3274437462
Enrollment ID: O20031120000241
Entity NameOsh - Pa Physicians Group, Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1811405533
PECOS PAC ID: 7517213879
Enrollment ID: O20180629000414

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. Ms Samala 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 AddressPractice Location Address
Ms Samala Jackson, CRNP
Po Box 40412,
Belfast, ME 04915-1255

Ph: (248) 824-6500		Ms Samala Jackson, CRNP
1055 Westlakes Dr Ste 3152,
Berwyn, PA 19312-2410

Ph: (215) 346-6050

Reviews and Comments


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Mary Evans Greene,
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Phone: 109-950-1006    Fax: 109-950-4006
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Mrs. Margareth Fontaine,
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Patricia A Gillin,
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Nikkira T Townsend, CRNP
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Phone: 610-251-2525    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.