Individual provider Active NPI

Jesse Michael Callan, MSW, LCSW-C

  • Clinical Social Worker
  • Baltimore, MD
National Provider Identifier
1124295605
Registry record updated Jan 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
1012 S North Point Rd
Baltimore, MD 21224-3338
Phone
(443) 216-4800
NPI assigned
May 13, 2008
Last updated
Jan 13, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2011

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 Primary

Addresses

Primary practice location

1012 S North Point Rd
Baltimore, MD 21224-3338

Mailing address

5603 Belle Vista Ave
Baltimore, MD 21206-3439
Phone (443) 874-2525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20110119000494 MD Practitioner - Clinical Social Worker 6800075128 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thrive Behavioral Health, LLCGroup PAC ID 3476777947, 62 clinicians

Practice addresses (Care Compare)

9627 Philadelphia Rd
Suite 160
Rosedale, MD 21237-4157
Phone (410) 780-5203

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14026MDMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Behavioral Health, LLC Current Accepting new patients
Thrive Behavioral Health, LLC CurrentSince Jun 15, 2014 Accepting new patients
Thrive Behavioral Health, LLC CurrentSince Jun 15, 2014 Accepting new patients

Locations

1114 Benfield Blvd
Ste G
Millersville, MD 21108
Phone (410) 780-4320

8967 Yellow Brick Rd
#A
Rosedale, MD 21237
Phone (410) 780-4320

9627 Philadelphia Rd
Ste 160
Rosedale, MD 21237
Phone (410) 780-5205

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294876800000",
    "number": "1124295605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5603 BELLE VISTA AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212063439",
            "telephone_number": "443-874-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 S NORTH POINT RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212243338",
            "telephone_number": "443-216-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLAN",
        "first_name": "JESSE",
        "middle_name": "MICHAEL",
        "credential": "MSW, LCSW-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-13",
        "last_updated": "2011-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.