Ms Syreeta Lea Jackson, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Providence, Rhode Island. Her current practice location is
360 Duncan Dr, Providence, Rhode Island. You can reach out to her office (for appointments etc.) via phone at
(401) 921-9042.
Ms Syreeta Lea Jackson is licensed to practice in Rhode Island (license number CSW02776) 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 1982341681.
Healthcare Provider's Profile
| Full Name | Ms Syreeta Lea Jackson |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 360 Duncan Dr, Providence, Rhode Island |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1982341681
- Provider Enumeration Date: 05/16/2022
- Last Update Date: 09/12/2022
Medicare PECOS Information:
- PECOS PAC ID: 0648646414
- Enrollment ID: I20221019001116
Medical Identifiers
Medical identifiers for Ms Syreeta Lea Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1982341681 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | CSW02776 (Rhode Island) | 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 Syreeta Lea Jackson allows following entities to bill medicare on her behalf.
| Entity Name | The Providence Center Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1104847946
PECOS PAC ID: 9739080292
Enrollment ID: O20040116000840 |
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| Entity Name | Supportive Care I Of Rhode Island Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1912666454
PECOS PAC ID: 1951793546
Enrollment ID: O20220111000885 |
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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. Ms Syreeta Lea 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 |
|---|
Ms Syreeta Lea Jackson, LCSW
360 Duncan Dr,
Providence, RI 02906-7003
Ph: (401) 921-9042 | Ms Syreeta Lea Jackson, LCSW
360 Duncan Dr,
Providence, RI 02906-7003
Ph: (401) 921-9042 |
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