Individual provider Active NPI

Jill Blank, MSW,LCSW

  • Social Worker
  • Rhinelander, WI
National Provider Identifier
1083802375
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
7756 Issued in WI
Practice address
1020 Kabel Ave
Rhinelander, WI 54501
Phone
(715) 361-2805
NPI assigned
Oct 11, 2007
Last updated
Sep 28, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 7756 WI Primary
Clinical Social Worker 1041C0700X 149003320 IL

Addresses

Primary practice location

1020 Kabel Ave
Rhinelander, WI 54501

Mailing address

1020 Kabel Ave
Rhinelander, WI 54501-3918
Phone (715) 361-2805

Other practice location 1

2907 Butterfield Rd
Suite 240Domestic Business Mailing Address Information
Oak Brook, IL 60523-1175
Phone (630) 586-0900 ext. 24

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20110713000113 WI Practitioner - Clinical Social Worker 0244408599

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus Rhinelander and Tomahawk Hospitals and Clinics, Inc.Group PAC ID 9335059856, shared by 17 NPIs, 566 clinicians

Practice addresses (Care Compare)

1630 Chippewa Dr
Rhinelander, WI 54501-9503
Phone (715) 361-5480

240 Maple St
Woodruff, WI 54568-9190
Phone (715) 356-8140

Merit-based Incentive Payment System (MIPS)

Final score
87.84 of 100Reported as group
Quality
86.21
Promoting interoperability
100
Improvement activities
40
Cost
73.25

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7756WIMDMental Health Counselor
149003320ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1083802375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 KABEL AVE",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "545013918",
            "telephone_number": "715-361-2805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 KABEL AVE",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "54501",
            "telephone_number": "715-361-2805"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2907 Butterfield Rd",
            "address_2": "Suite 240Domestic Business Mailing Address Information",
            "address_purpose": "LOCATION",
            "city": "Oak Brook",
            "state": "IL",
            "postal_code": "605231175",
            "country_code": "US",
            "telephone_number": "630-586-0900 x24",
            "fax_number": "630-586-9990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLANK",
        "first_name": "JILL",
        "credential": "MSW,LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-11",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "7756",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149003320",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rhinelander, WI

Sources for this page

Verify at the official NPI Registry.