Individual provider Active NPI

Adrian D Jurkiw, LISW-S

  • Clinical Social Worker
  • Cleveland, OH
National Provider Identifier
1154622603
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I1200834-SUPV Issued in OH
Practice address
4500 Euclid Ave
Cleveland, OH 44103-3736
Phone
(216) 325-9355
NPI assigned
Nov 15, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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 I1200834-SUPV OH Primary

Addresses

Primary practice location

4500 Euclid Ave
Cleveland, OH 44103-3736

Mailing address

4500 Euclid Ave
Cleveland, OH 44103-3736
Phone (216) 325-9404

Other identifiers 1

IdentifierTypeStateIssuer
0182589MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20130702000719 OH Practitioner - Clinical Social Worker 2769622398 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I1200834-SUPVOHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Centers for Families and Children Social Worker CurrentSince Aug 28, 2015 Accepting new patients
Center for Families & Children CurrentSince Aug 28, 2015 Accepting new patients
Circle Health Services CurrentSince Oct 2, 2023 Accepting new patients
Circle Health Services CurrentSince Oct 2, 2023 Accepting new patients
Circle Health Services Past Accepting new patients

Locations

4500 Euclid Ave
Cleveland, OH 44103
Phone (216) 325-9404

4400 Euclid Ave
Cleveland, OH 44103
Phone (216) 325-9355

12201 Euclid Ave
Cleveland, OH 44106
Phone (216) 373-2846

3929 Rocky River Dr
Cleveland, OH 44111
Phone (216) 252-5800

5209 Detroit Ave
Cleveland, OH 44102
Phone (216) 651-2037

5955 Ridge Rd
Parma, OH 44129
Phone (440) 888-0300

Organizations & group practices 5

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": "1289779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1154622603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441033736",
            "telephone_number": "216-325-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441033736",
            "telephone_number": "216-325-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JURKIW",
        "first_name": "ADRIAN",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-15",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I1200834-SUPV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0182589",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.