ANDREA MARIE JACKSON (PHD) – Psychologist, NPI 1194255877
Psychologist
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
647 CLINICAL PSYCHOLOGIST in OR
Provider Addresses for ANDREA MARIE JACKSON (PHD)
PO BOX 1188
CORVALLIS, OR 973391188
Phone:
Type: Mailing
534 PLEASANT VIEW WAY NW STE 200
ALBANY, OR 973211789
Phone: (541) 812-5760
Type: Location
534 Pleasant View Way NW Ste 200
Albany, OR 973211789
Phone: (541) 812-5760
Type: Location
170 MELTON RD
CRESWELL, OR 974269453
Phone: (541) 306-6456
Type: Mailing
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.
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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: 2019-09-05
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 |
|---|---|---|---|---|
| I20190905003099 | I | Clinical Psychologist | OR | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 96139 | Administration of psychological or neuropsychological test by technician, each additional 30 minutes | 633 | 83 | $0 |
| 96133 | Evaluation of neuropsychological test, each additional hour | 215 | 87 | $0 |
| 90791 | Psychiatric diagnostic evaluation | 92 | 92 | $0 |
| 96132 | Evaluation of neuropsychological test, first hour | 89 | 89 | $0 |
| 96138 | Administration of psychological or neuropsychological test by technician, first 30 minutes | 84 | 84 | $0 |
Insurance plans in this area (ZIP 97339)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | MI | |
| P S Y C H I A T R Y | MI | |
| Clinical Social Worker | MI | |
| Clinical Social Worker | IN | |
| Clinical Social Worker | MI | |
| P S Y C H I A T R Y | MI | |
| Clinical Social Worker | MI | |
| Mental Health Counselor | OR | |
| Marriage And Family Therapist | WA | |
| Clinical Social Worker | MN |
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