Individual provider Active NPI

Deborah L Hedges, LCSW

  • Clinical Social Worker
  • Evansville, IN
National Provider Identifier
1164771564
Registry record updated Oct 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34007451A Issued in IN
Practice address
4411 Washington Ave
Attn: Davina Jenkins
Evansville, IN 47714-0805
Phone
(812) 479-1916
Fax
(812) 479-5014
NPI assigned
Aug 31, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2016

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 34007451A IN Primary

Addresses

Primary practice location

4411 Washington Ave
Attn: Davina Jenkins
Evansville, IN 47714-0805

Mailing address

4411 Washington Ave
Attn: Davina Jenkins
Evansville, IN 47714-0805
Phone (812) 479-1916

Other identifiers 1

IdentifierTypeStateIssuer
200238820MedicaidIN

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160205000295 IN Practitioner - Clinical Social Worker 5395049712 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34007451AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Clinical CurrentSince Dec 19, 2024 Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

9465 Counselors Row
Ste 200
Indianapolis, IN 46240
Phone (463) 220-4646

Organizations & group practices 1

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": "1346371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477526400000",
    "number": "1164771564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 WASHINGTON AVE",
            "address_2": "ATTN: DAVINA JENKINS",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140805",
            "telephone_number": "812-479-1916",
            "fax_number": "812-479-5014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 WASHINGTON AVE",
            "address_2": "ATTN: DAVINA JENKINS",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140805",
            "telephone_number": "812-479-1916",
            "fax_number": "812-479-5014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEDGES",
        "first_name": "DEBORAH",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-31",
        "last_updated": "2016-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007451A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200238820",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.