Individual provider Active NPI

Crystal Newkirk Jones, LCSW, LISW-CP

  • Clinical Social Worker
  • West Columbia, SC
National Provider Identifier
1235417775
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11789 Issued in SC
Practice address
160 Medical Cir FL 1
West Columbia, SC 29169-3639
Phone
(803) 796-6811
Fax
(803) 796-6851
NPI assigned
Aug 2, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X P005855 NC
Clinical Social Worker 1041C0700X C008599 NC
Clinical Social Worker 1041C0700X 11789 SC Primary

Addresses

Primary practice location

160 Medical Cir FL 1
West Columbia, SC 29169-3639

Mailing address

747 Edenhall Dr
Columbia, SC 29229-7092
Phone (919) 368-2417

Other practice location 1

501 Billingsley Rd
Suite B
Charlotte, NC 28211-1009
Phone (704) 444-2400

Other identifiers 2

IdentifierTypeStateIssuer
1235417775MedicaidNC
SW1296MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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

Enrollment IDStateProvider typePAC IDDetails
I20221103003034 SC Practitioner - Clinical Social Worker 5092024448 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolina Psychiatric Services IncGroup PAC ID 5991792046, 6 clinicians

Practice addresses (Care Compare)

160 Medical Cir
FL 1
West Columbia, SC 29169-3639
Phone 803796681111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P005855NCMDClinical Social Worker
11789SCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Psychiatric Services, Inc Clinical CurrentSince Aug 8, 2022 Accepting new patients

Locations

160 Medical Cir
Fl 1
West Columbia, SC 29169
Phone (803) 796-6811

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": "1312243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1235417775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 EDENHALL DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292297092",
            "telephone_number": "919-368-2417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 MEDICAL CIR FL 1",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291693639",
            "telephone_number": "803-796-6811",
            "fax_number": "803-796-6851"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 Billingsley Rd",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282111009",
            "country_code": "US",
            "telephone_number": "704-444-2400",
            "fax_number": "704-358-2716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JONES",
        "first_name": "CRYSTAL",
        "middle_name": "NEWKIRK",
        "credential": "LCSW, LISW-CP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-02",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P005855",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C008599",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "11789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235417775",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SW1296",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Columbia, SC

Sources for this page

Verify at the official NPI Registry.