SAMUEL BARRETT JACKSON (MD) – Internal Medicine Physician, NPI 1689105223
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,016 CARDIOVASCULAR DISEASE (CARDIOLOGY) in CA
Provider Addresses for SAMUEL BARRETT JACKSON (MD)
1501 TROUSDALE DR
BURLINGAME, CA 940104506
Phone: (650) 652-8600
Type: Location
757 Westwood Plz Ste 7501
Los Angeles, CA 900957417
Phone: (310) 825-6301
Type: Location
200 Ucla Medical Plz Ste 400
Los Angeles, CA 900957417
Phone: (310) 206-6232
Fax: (310) 206-3551
Type: Location
200 UCLA MEDICAL PLZ STE 400
LOS ANGELES, CA 900957417
Phone: (310) 206-6232
Fax: (310) 206-3551
Type: Location
5767 W CENTURY BLVD STE 400
LOS ANGELES, CA 900455631
Phone: (310) 301-8771
Fax: (310) 301-8751
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 9 Open Payments records for all available years, with a total value of $406.
Total Amount is formed as General ($406) + Research ($0) + Ownership ($0) = $406.
Last reported payment date: 2024-12-26 • Largest payer in this snapshot: Shockwave Medical, Inc ($330).
Total Amount
$406
General + Research + Ownership
Payments
9
Total payment records
General Amount
$406
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-26
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Shockwave Medical, Inc | $330 |
| Abbott Laboratories | $22 |
| ABIOMED | $20 |
| Cardiovascular Systems Inc. | $18 |
| W. L. Gore & Associates, Inc. | $17 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-05-22
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20200522002490 | I | Cardiovascular Disease (Cardiology) | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 94010)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| A L L E R G Y/ I M M U N O L O G Y | CA | |
| - | CA | |
| Obstetrics/Gynecology, Hospitalist | CA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | OR | |
| - | CA | |
| - | CA | |
| - | CA | |
| - | CA | |
| A N E S T H E S I O L O G Y | CA | |
| G A S T R O E N T E R O L O G Y | CA |
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