Jeannie Marie Baca
Individual provider Active NPI Social Worker · Roxbury, MA
NPI 1174872147 · NPPES record last updated Jan 17, 2024
Key facts
- NPI
- 1174872147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 119874 (MA)
- Practice address
- 435 Warren St
Roxbury, MA 02119-1833 - Phone
- (617) 442-7400
- NPI assigned
- Sep 5, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Codman Square Health Center, Inc
Practice addresses (Care Compare)
637 Washington St
Dorchester, MA 02124-3510
Phone (617) 825-9660
Hospital & facility affiliations
- Boston Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170213002124 | MA | Practitioner - Clinical Social Worker | 9739462979 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119874 | MA | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boston Medical Center Corporation | Current | Accepting new patients | |
| Codman Square Health Center Inc | Current |
Accepting new patients | |
| Roxbury Comprehensive Community Health Center, Inc. | Past |
Accepting new patients | |
| Roxbury Comprehensive Community Health Center | Social Worker | Past | Accepting new patients |
Locations
637 Washington St
Dorchestr Ctr, MA 02124
Phone (617) 822-8211
Interoperability endpoints
- jbaca182113@direct.bmc.masshiway.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 119874 | MA | Yes |
Addresses
Primary practice location
435 Warren St
Roxbury, MA 02119-1833
Mailing address
637 Washington St
Dorchester, MA 02124-3510
Phone (617) 825-9660
Other practice location 1
637 Washington St
Dorchester, MA 02124-3510
Phone (617) 825-9660
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110120605A | Medicaid | MA |
Other providers in Roxbury, MA
- Malika Arty
- Khaled Mohamed Asaad
- Katharyn M Atkins
- Atlantis Physical Therapy Group,Inc,
- Ayan Personal Care Assistance
- David Paz Bacani
- Alyssa Fae Bacay
- Magdy Sami Badereldin
- Alicia Baez
- Furkan Bahar
All providers in Roxbury, MA · Social Worker in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.