Individual provider Active NPI

Rebecca K Smith, LCSW

  • Clinical Social Worker
  • Jackson, KY
National Provider Identifier
1174836662
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
253299 Issued in KY
Practice address
1484 Lakeside Drive
Jackson, KY 41339-6555
Phone
(606) 666-9950
Fax
(606) 666-9136
NPI assigned
Jul 26, 2010
Last updated
Mar 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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 253299 KY Primary

Addresses

Primary practice location

1484 Lakeside Drive
Jackson, KY 41339-6555

Mailing address

PO Box 690
Beattyville, KY 41311-0690
Phone (606) 464-0151

Other identifiers 1

IdentifierTypeStateIssuer
253299OtherKYLCSW LICENSURE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20230623002197 KY Practitioner - Clinical Social Worker 0749648764 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Juniper Health IncGroup PAC ID 2961453618, 22 clinicians

Practice addresses (Care Compare)

1484 Lakeside Dr
Jackson, KY 41339-7370
Phone (606) 666-9950

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
253299KYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Juniper Health Inc Current Accepting new patients
QPS LLC CurrentSince May 15, 2023 Accepting new patients
Juniper Health Inc CurrentSince May 15, 2023 Accepting new patients
Juniper Health Inc Past Accepting new patients
Juniper Health Inc Past Accepting new patients
Juniper Health Inc Past Accepting new patients

Locations

1025 Grand Ave
Beattyville, KY 41311
Phone (606) 464-2401

1665 Highway 11 S
Beattyville, KY 41311
Phone (606) 464-2401

599 Lee Ave
Beattyville, KY 41311
Phone (606) 464-2401

10355 Highway 30 W
Booneville, KY 41314
Phone (606) 666-9950

2085 US Highway 460 E
Frenchburg, KY 40322
Phone (606) 768-3725

11134 KY Highway 191
Hazel Green, KY 41332
Phone (606) 662-8252

1484 Lakeside Dr
Jackson, KY 41339
Phone (606) 666-9950

2307 Bobcat Ln
Jackson, KY 41339
Phone (606) 666-9950

940 Highland Ave
Jackson, KY 41339
Phone (606) 666-4979

141 Main St
Old Landing, KY 41311

1745 Ky 715
Rogers, KY 41365
Phone (606) 668-7385

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1174836662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "413110690",
            "telephone_number": "606-464-0151",
            "fax_number": "606-464-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1484 LAKESIDE DRIVE",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413396555",
            "telephone_number": "606-666-9950",
            "fax_number": "606-666-9136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "REBECCA",
        "middle_name": "K",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-26",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "253299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW LICENSURE",
            "identifier": "253299",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, KY

Sources for this page

Verify at the official NPI Registry.