Jeremy Shane Wilson, CSW, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

S.1000131 Issued in OH

Practice address

5400 Edalbert Dr
Cincinnati, OH 45239-7604

Phone

(859) 536-5808

Fax

(513) 741-5686

NPI assigned

Jan 5, 2018

Sex

Male

Sole proprietor

No

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 OH, KY2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2009

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

  KY, OH

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1515110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515110400000",
    "number": "1245747757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 EDALBERT DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452397604",
            "telephone_number": "513-741-3100",
            "fax_number": "513-741-5686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 EDALBERT DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452397604",
            "telephone_number": "859-536-5808",
            "fax_number": "513-741-5686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JEREMY",
        "middle_name": "SHANE",
        "name_prefix": "Mr.",
        "credential": "CSW, LSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-05",
        "last_updated": "2018-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1000131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaclyn Wilson, NP
• Jada Wilson
• James Wilson
• Jasmine I Wilson
• Jasmine T Wilson
• Jessica Ann Wilson, APRN
• John H Wilson, M.D.
• Joy A Wilson, ED.D. LPCC-SC
• Julie A Wilson
• Kathleen Wilson, PHARMD

• Social Worker in Cincinnati, OH
• Providers in Cincinnati, 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 5, 2018; 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.