Individual provider Active NPI

Jesse Wodrig, CDCA

  • Addiction (Substance Use Disorder) Counselor
  • Ashtabula, OH
National Provider Identifier
1144727678
Registry record updated Apr 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
140556 Issued in OH
Practice address
2801 C CT
Ashtabula, OH 44004-4577
Phone
(440) 998-0722
Fax
(440) 992-1699
NPI assigned
Apr 11, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 140556 OH Primary

Addresses

Primary practice location

2801 C CT
Ashtabula, OH 44004-4577

Mailing address

2801 C CT
Ashtabula, OH 44004-4577
Phone (440) 998-0722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
140556OHMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Area Recovery Center Current Accepting new patients
Lake Area Recovery Center Current Accepting new patients
Ohio Gambling Telehealth Network Past Accepting new patients

Locations

2801 C Ct
Ashtabula, OH 44004
Phone (440) 998-0722

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523404800000",
    "number": "1144727678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 C CT",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440044577",
            "telephone_number": "440-998-0722",
            "fax_number": "440-992-1699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 C CT",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440044577",
            "telephone_number": "440-998-0722",
            "fax_number": "440-992-1699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WODRIG",
        "first_name": "JESSE",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-11",
        "last_updated": "2018-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "140556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashtabula, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.