Jessica Ann Waller, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8857-C Issued in NV

Practice address

1665 Old Hot Springs Rd
Carson City, NV 89706-0782

Phone

(775) 687-0874

NPI assigned

Jul 20, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NV

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

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of NevadaGroup PAC ID 9234022153, 57 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• State of Nevada

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ely, NV
  • NPI 1760572010
  Medicare reassignment Care Compare group NPD
• State of Nevada

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fernley, NV
  • NPI 1013099944
  NPD
• State of Nevada

  • Skilled Nursing Facility
  • Boulder City, NV
  • NPI 1083612741
  NPD
• State of Nevada

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Winnemucca, NV
  • NPI 1275623530
  NPD (past)
• State of Nevada

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Silver Springs, NV
  • NPI 1811079742
  NPD (past)

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

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637280000000",
    "number": "1194333732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2731 CLAPHAM LN",
            "city": "MINDEN",
            "state": "NV",
            "postal_code": "894239235",
            "telephone_number": "775-720-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 OLD HOT SPRINGS RD",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897060782",
            "telephone_number": "775-687-0874"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2731 Clapham Ln",
            "address_purpose": "LOCATION",
            "city": "Minden",
            "state": "NV",
            "postal_code": "894239235",
            "country_code": "US",
            "telephone_number": "775-720-1802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-20",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "8857-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Minden",
            "affiliation": "N",
            "address_1": "2731 Clapham Ln",
            "city": "Minden",
            "state": "NV",
            "country_code": "US",
            "postal_code": "894239235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dana Joyce Walburn, LCSW
• Walgreen Co
• Beau Walker, DMD
• Jared A Walker
• William Scott Wall, PT
• Joseph Patrick Walls, MD
• Walmart Inc.
• Walmart Inc.
• Walmart, Inc.
• Alicia Walsh, M.S., CCC-SLP

• Clinical Social Worker in Carson City, NV
• Providers in Carson City, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.