Individual provider Active NPI

Jenna Nomeland, LICSW

  • Clinical Social Worker
  • Saint Paul, MN
National Provider Identifier
1053716746
Registry record updated Jun 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
27116 Issued in MN
Practice address
649 Dayton Ave
Saint Paul, MN 55104-6631
Phone
(612) 436-4840
Fax
(612) 436-2604
NPI assigned
Oct 24, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 27116 MN Primary

Addresses

Primary practice location

649 Dayton Ave
Saint Paul, MN 55104-6631

Mailing address

649 Dayton Ave
Saint Paul, MN 55104-6631
Phone (612) 436-4840

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200528000044 MN Practitioner - Clinical Social Worker 0446671556 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

649 Dayton Ave
Saint Paul, MN 55104-6631
Phone (612) 436-4840

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27116MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Victims of Torture CurrentSince Apr 19, 2020 Accepting new patients
Center for Victims of Torture - Bethesda Past Accepting new patients

Locations

2356 University Ave W
Ste 430
Saint Paul, MN 55114

649 Dayton Ave
Saint Paul, MN 55104
Phone (612) 436-4840

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1053716746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "649 DAYTON AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551046631",
            "telephone_number": "612-436-4840",
            "fax_number": "612-436-2604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "649 DAYTON AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551046631",
            "telephone_number": "612-436-4840",
            "fax_number": "612-436-2604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOMELAND",
        "first_name": "JENNA",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-24",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.