Individual provider Active NPI

Kerri Anne Evans, LCSW

  • Clinical Social Worker
  • Orange Park, FL
National Provider Identifier
1073199725
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW18136 Issued in FL
Practice address
1532 Kingsley Ave Ste 112
Orange Park, FL 32073-4536
Phone
(904) 214-3222
Fax
(904) 621-9140
NPI assigned
Mar 23, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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 SW18136 FL Primary

Addresses

Primary practice location

1532 Kingsley Ave Ste 112
Orange Park, FL 32073-4536

Mailing address

1532 Kingsley Ave Ste 112
Orange Park, FL 32073-4536
Phone (904) 214-3222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20210824001283 FL Practitioner - Clinical Social Worker 7618372020 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dna Comprehensive Therapy Services LLCGroup PAC ID 2860619632, 446 clinicians

Practice addresses (Care Compare)

1532 Kingsley Ave
Suite 112
Orange Park, FL 32073-4536
Phone (904) 214-3222

Merit-based Incentive Payment System (MIPS)

Final score
87.43 of 100Reported as group
Quality
74.02
Promoting interoperability
100
Improvement activities
40
Cost
77.26

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW18136FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bonita Springs Retirement Village, Inc. CurrentSince Jul 15, 2023 Accepting new patients
Pathways Resolution Center, Inc. CurrentSince Mar 26, 2023 Accepting new patients
Dna Comprehensive Therapy Services, LLC Clinical CurrentSince Jul 15, 2023 Accepting new patients

Locations

4310 Metro Pkwy
Ste 205
Fort Myers, FL 33916

1532 Kingsley Ave
Ste 115
Orange Park, FL 32073
Phone (904) 254-0332

1532 Kingsley Ave
Ste 112
Orange Park, FL 32073
Phone (904) 214-3222

3191 Harbor Blvd
Ste A
Pt Charlotte, FL 33952
Phone (941) 766-9555

1965 Capital Cir NE
Ste 102
Tallahassee, FL 32308
Phone (850) 671-4600

5825 Argerian Dr
Ste 101
Wesley Chapel, FL 33545
Phone (813) 687-4870

Interoperability endpoints

  • Direct secure messaging: kerri.evans.1@13142.direct.athenahealth.com

Organizations & group practices 3

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": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1073199725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1532 KINGSLEY AVE STE 112",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734536",
            "telephone_number": "904-214-3222",
            "fax_number": "904-621-9140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1532 KINGSLEY AVE STE 112",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734536",
            "telephone_number": "904-214-3222",
            "fax_number": "904-621-9140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "KERRI",
        "middle_name": "ANNE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-23",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW18136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.