Jaclynn E Ellis, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2304667-SUPV Issued in OH

Practice address

527 N Meridian Rd
Youngstown, OH 44509-1227

Phone

(330) 797-0070

Fax

(330) 797-9146

NPI assigned

May 6, 2021

Sex

Female

Sole proprietor

No

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 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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Meridian Healthcare

  • Federally Qualified Health Center (FQHC)
  • Youngstown, OH
  • NPI 1528918703

  W-2 Managing Employee

  CMS ownership
• Meridian Healthcare

  • Federally Qualified Health Center (FQHC)
  • Youngstown, OH
  • NPI 1700737277

  W-2 Managing Employee

  CMS ownership

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.

• Meridian Healthcare

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Youngstown, OH
  • NPI 1356307235

  Social Worker

  Medicare reassignment NPD
• Meridian Healthcare

  • Primary Care Clinic/Center
  • Youngstown, OH
  • NPI 1225455082
  NPD
• Meridian Healthcare

  • Federally Qualified Health Center (FQHC)
  • Youngstown, OH
  • NPI 1841164365
  NPD

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

{
    "created_epoch": "1620259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1174107270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 N MERIDIAN RD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445091227",
            "telephone_number": "330-797-0070",
            "fax_number": "330-797-9146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 N MERIDIAN RD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445091227",
            "telephone_number": "330-797-0070",
            "fax_number": "330-797-9146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JACLYNN",
        "middle_name": "E",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-06",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2304667-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trace Elling-Cockerell
• Lorneeshia Elliott
• Blake Michael Ellis, DO
• Denise Ellis
• Ezekiel Ellis
• Joy Ellis
• Kaitlynn Elizabeth Ellis
• Shannon Ellis
• Tawana Lakeisha Ellis
• Trey Carter Ellis

• Clinical Social Worker in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.