Kelli Renee Deckard, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34010292A Issued in IN

Practice address

482 S Landmark Ave
Bloomington, IN 47403-5000

Phone

(812) 333-8474

NPI assigned

Mar 17, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jennifer Spencer PHD HSPP PCGroup PAC ID 0244384758, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Jennifer Spencer PHD HSPP PC

  • Community/Behavioral Health Agency
  • Bloomington, IN
  • NPI 1932331345
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1679011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679011200000",
    "number": "1144922915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4240 N RIDGEWOOD DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474049640",
            "telephone_number": "812-361-3454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035000",
            "telephone_number": "812-333-8474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "817 W 17th St Ste 2",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474043333",
            "country_code": "US",
            "telephone_number": "812-361-3454",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DECKARD",
        "first_name": "KELLI",
        "middle_name": "RENEE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-17",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34010292A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Rose Deboy, BCBA
• David Debruicker
• Marjorie Debruyne, RD, CDE
• Brandy L. Deckard, O.D.
• Hillary Dee Deckard, OT
• Natalie Eve Decook, OD
• Jeffrey Alan Dedelow, M.D.
• Jodie Deem
• Katherine E Deer, APRN
• Alexis Renee Deetz

• Clinical Social Worker in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.