Active NPI
Jessica Shaffer, LISW-S
- Clinical Social Worker
- Newark, OH
National Provider Identifier
1043669179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 15 N 3Rd St
Suite 200
Newark, OH 43055-5550 - Phone
- (740) 349-7511
- Fax
- (740) 522-4263
- NPI assigned
- Jun 9, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary | ||
| Social Worker | 104100000X | I0900294 | OH |
Addresses
Primary practice location
15 N 3Rd St
Suite 200
Newark, OH 43055-5550
Mailing address
15 N 3Rd St
Suite 200
Newark, OH 43055-5550
Phone (740) 349-7511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2892946 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I0900294 | OH | MD | Social Worker |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Canton, OH
- NPI 1679721906
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649203200000",
"number": "1043669179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 N 3RD ST",
"address_2": "SUITE 200",
"city": "NEWARK",
"state": "OH",
"postal_code": "430555550",
"telephone_number": "740-349-7511",
"fax_number": "740-522-4263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 N 3RD ST",
"address_2": "SUITE 200",
"city": "NEWARK",
"state": "OH",
"postal_code": "430555550",
"telephone_number": "740-349-7511",
"fax_number": "740-522-4263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFFER",
"first_name": "JESSICA",
"credential": "LISW-S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-09",
"last_updated": "2022-04-06",
"certification_date": "2022-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "I0900294",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2892946",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.