Sally Ann Davis-Jackson, MSW, PLMHP, CSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12003 Issued in NE

Practice address

202 E Highway 20
Bassett, NE 68714-6052

Phone

(402) 684-2908

NPI assigned

Nov 1, 2019

Last updated

Nov 1, 2019By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NE

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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midwest Country Clinic LLCGroup PAC ID 2466768809, 4 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Midwest Country Clinic LLC

  • Mental Health Counselor
  • Bassett, NE
  • NPI 1417155433

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Sandhills Behavioral Services LLC

  • Mental Health Counselor
  • Ainsworth, NE
  • NPI 1033646799

  Single Specialty

  NPD

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

{
    "created_epoch": "1572566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572566400000",
    "number": "1225672371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26",
            "city": "BASSETT",
            "state": "NE",
            "postal_code": "687140026",
            "telephone_number": "402-684-2908",
            "fax_number": "402-913-3454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E HIGHWAY 20",
            "city": "BASSETT",
            "state": "NE",
            "postal_code": "687146052",
            "telephone_number": "402-684-2908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS-JACKSON",
        "first_name": "SALLY",
        "middle_name": "ANN",
        "credential": "MSW, PLMHP, CSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-01",
        "last_updated": "2019-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NE",
            "license": "12003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alvin Ortega Benemerito, RPT
• Shanda Dae Benemerito, OTR/L, CPAM
• Kathy J Carr
• Lynn D Cooper, PLMHP
• Joshua Coyle
• Melissa Dearmont, MSW,LICSW, LIMHP, CM
• Brittany Devall Heyden
• Jennifer Einspahr
• Greater Sandhills Family Healthcare, PC
• Shelly Herrington, NP

• Clinical Social Worker in Bassett, NE
• Providers in Bassett, NE by specialty
• Clinical Social Worker in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; 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.