Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Samuel Wesley Jackson, MD

Individual provider Psychiatry Physician · NPI 1114480001

Samuel Wesley Jackson, MD is a Psychiatry in Chicago, Illinois. Qualified in 2019, 7 years ago. Practices with Erie Family Health Center, Inc, a 142-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
7
Licensed in
IL
In the registry since
2019
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

5215 N California Ave Fl 7
Chicago, IL 60625-7014
Phone: (718) 270-8867
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X · Licence 169934 (IL)

Record details

NPI number1114480001
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 9, 2019
Last updated in NPPESNovember 26, 2024
Certification dateNovember 26, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPSYCHIATRY
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Erie Family Health Center, Inc — 142 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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