MR. RICHARD ALLEN JACKSON (LICSW) – Clinical Social Worker, NPI 1629520770
Clinical Social Worker
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,310 CLINICAL SOCIAL WORKER in MN
Provider Addresses for MR. RICHARD ALLEN JACKSON (LICSW)
823, Maple Street, Brainerd, Crow Wing County, Minnesota, 56401, United States
BRAINERD, MN 564013770
Phone:
Type: Mailing
201 W Laurel St
Brainerd, MN 564013902
Phone: (218) 454-3844
Fax: (218) 454-3844
Type: Location
201, West Laurel Street, Westwood Mobile Home Park, Brainerd, Crow Wing County, Minnesota, 56401, United States
BRAINERD, MN 564013902
Phone: (218) 454-3844
Fax: (218) 454-3844
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2017-05-08
PECOS data refreshed: 2026-05-27
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 |
|---|---|---|---|---|
| I20170508000243 | I | Clinical Social Worker | MN | 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 56401)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Mental Health Counselor | MN | |
| Marriage And Family Therapist | MN | |
| Clinical Social Worker | MN | |
| Marriage And Family Therapist | MN | |
| Clinical Social Worker | MN |
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