NPIMap

Individual provider Active NPI

Jessica Marie Purvis, MSW, LCSW

  • Clinical Social Worker
  • Lebanon, IN
National Provider Identifier
1194020537
Registry record updated Apr 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34006957A Issued in IN
Practice address
940 Lasley Dr
Lebanon, IN 46052-1480
Phone
(765) 482-7421
Fax
(765) 482-7462
NPI assigned
Jan 16, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2014

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 34006957A IN Primary

Addresses

Primary practice location

940 Lasley Dr
Lebanon, IN 46052-1480

Mailing address

3117 Radford Dr
Indianapolis, IN 46226-6227
Phone (317) 650-5315

Other names 1

  • Jessica Marie Fail Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34006957AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Lexington Counseling and Psychiatry, PLLC Clinical Past Accepting new patients

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": "1295136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398297600000",
    "number": "1194020537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3117 RADFORD DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462266227",
            "telephone_number": "317-650-5315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 LASLEY DR",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521480",
            "telephone_number": "765-482-7421",
            "fax_number": "765-482-7462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURVIS",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-16",
        "last_updated": "2014-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34006957A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "FAIL",
            "middle_name": "MARIE",
            "credential": "MSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Lebanon, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.