Jill Nicole Keller, MSSA, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

S2105821 Issued in OH

Practice address

2587 Back Orrville Rd
Wooster, OH 44691-9523

Phone

(330) 264-9597

Fax

(330) 264-0946

NPI assigned

Sep 19, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sondermind Provider Network LLCGroup PAC ID 9537572490, 1,295 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  OH

  Medicare reassignment Care Compare group NPD
• Keller Counseling & Consulting LLC

  • Mental Health Counselor
  • Wooster, OH
  • NPI 1790461648
  NPD Authorized official
• Anazao Community Partners

  • Community/Behavioral Health Agency
  • Wooster, OH
  • NPI 1073873923
  NPD (past)
• Anazao Community Partners

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wooster, OH
  • NPI 1164471082
  NPD (past)

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

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1225512981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2587 BACK ORRVILLE RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446919523",
            "telephone_number": "330-264-9597",
            "fax_number": "330-264-0946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2587 BACK ORRVILLE RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446919523",
            "telephone_number": "330-264-9597",
            "fax_number": "330-264-0946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "JILL",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "MSSA, LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-19",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S1800589TRNE",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S2105821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandi Keith, LPN
• Justin Keith, QMHS-B
• Alexis N Kelbley
• Keller Counseling & Consulting LLC
• Deborah M Keller
• Ellen Marie Kelly, PA-C
• Gail Lynne Kelly
• K. Michelle Kelly, LSW, LPCC
• Lisa M. Kelly, MSW, LSW
• Michaela Kelly

• Social Worker in Wooster, OH
• Providers in Wooster, OH by specialty
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.