Active NPI
Jeffrey T Rose, LCSW
- Clinical Social Worker
- Bowling Green, KY
National Provider Identifier
1275977605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1219
- Practice address
- 3255 Spring Hollow Ave
Bowling Green, KY 42104-4486 - Phone
- (270) 779-7395
- NPI assigned
- Apr 29, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1219 | KY | Primary |
Addresses
Primary practice location
3255 Spring Hollow Ave
Bowling Green, KY 42104-4486
Mailing address
PO Box 50908
Bowling Green, KY 42102-4208
Phone (270) 779-7395
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130528000200 | KY | Practitioner - Clinical Social Worker | 3779721048 | Practice locations: Bowling Green, KY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1995
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3255 Spring Hollow Ave
Bowling Green, KY 42104-4486
Phone (270) 782-3583
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1219 | KY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367193600000",
"number": "1275977605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 50908",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421024208",
"telephone_number": "270-779-7395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3255 SPRING HOLLOW AVE",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421044486",
"telephone_number": "270-779-7395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "JEFFREY",
"middle_name": "T",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-04-29",
"last_updated": "2013-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KY",
"license": "1219",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowling Green, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2013; 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.