Samuel Jackson, MD
NPI 1114480001 · Psychiatry Physician · Chicago, IL
Enrolled with Medicare as Practitioner - Psychiatry · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Samuel Jackson, MD is a Psychiatry Physician provider in Chicago, IL (NPI 1114480001).
Provider details
- NPI number
- 1114480001
- Entity type
- Individual
- Primary specialty
- Psychiatry PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 169934 (IL)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2019-04-09
- Last updated
- 2024-11-26
- Certified
- 2024-11-26
Frequently asked questions
- What is Samuel Jackson's NPI number?
- Samuel Jackson's National Provider Identifier (NPI) is 1114480001, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Samuel Jackson's specialty?
- Samuel Jackson is listed in the NPPES registry with a primary specialty of Psychiatry Physician (Allopathic & Osteopathic Physicians).
- Where is Samuel Jackson located?
- Samuel Jackson's practice location on file with NPPES is 5215 N California Ave Fl 7, Chicago, IL 60625-7014.
- What is Samuel Jackson's phone number?
- The practice phone number listed in the NPPES registry for Samuel Jackson is (718) 270-8867.
- Does Samuel Jackson accept Medicare?
- Samuel Jackson is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Is Samuel Jackson's NPI active?
- Yes — Samuel Jackson's NPI (1114480001) is active in the NPPES registry as of the last update on 2024-11-26.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.