Active NPI
Jessica Kathleen Gent Ryder, L.C.S.W.
- Clinical Social Worker
- Bloomington, IL
National Provider Identifier
1154787992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.014207
- Practice address
- 200 W Monroe St
Suite #305
Bloomington, IL 61701-3997 - Phone
- (309) 838-9310
- NPI assigned
- Jan 9, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.014207 | IL | Primary |
Addresses
Primary practice location
200 W Monroe St
Suite #305
Bloomington, IL 61701-3997
Mailing address
1904 E Taylor St
Bloomington, IL 61701-5714
Phone (309) 838-9310
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221004000805 | IL | Practitioner - Clinical Social Worker | 6608252382 | Practice locations: Bloomington, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2103 E Washington St
Suite 2F
Bloomington, IL 61701-4365
Phone (309) 838-9310
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.014207 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458432000000",
"number": "1154787992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1904 E TAYLOR ST",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617015714",
"telephone_number": "309-838-9310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W MONROE ST",
"address_2": "SUITE #305",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617013997",
"telephone_number": "309-838-9310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYDER",
"first_name": "JESSICA",
"middle_name": "KATHLEEN GENT",
"name_prefix": "Mrs.",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-09",
"last_updated": "2016-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.014207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2016; 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.