Jay Sean Fallon, LLMSW
Individual provider Active NPI Social Worker · Utica, MI
NPI 1245663111 · NPPES record last updated Aug 15, 2013
Key facts
- NPI
- 1245663111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 6801095931 (MI)
- Practice address
- 11111 Hall Rd Ste 303
Utica, MI 48317-5726 - Phone
- (586) 997-3153
- NPI assigned
- Aug 15, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Wayne State University School of Medicine, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Wentworth and Associates PC
Health Emergency Assistance of Detroit
Practice addresses (Care Compare)
11111 Hall Rd
Suite 300
Utica, MI 48317-5726
Phone (586) 997-3153
1726 Howard St
Detroit, MI 48216-1921
Phone (313) 832-3300
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160802002782 | MI | Practitioner - Clinical Social Worker | 1850685611 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wentworth and Associates PC | Current |
Accepting new patients | |
| Health Emergency Assistance of Detroit | Current |
Accepting new patients |
Locations
1726 Howard St
Detroit, MI 48216
Phone (313) 338-3740
11111 Hall Rd
Ste 303
Utica, MI 48317
Phone (586) 739-0902
11111 Hall Rd
Ste 300
Utica, MI 48317
Phone (586) 323-2181
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801095931 | MI | Yes |
Addresses
Primary practice location
11111 Hall Rd Ste 303
Utica, MI 48317-5726
Mailing address
30739 Newport Dr
Warren, MI 48088-3163
Phone (586) 747-1150
Other providers in Utica, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.