Jill Elizabeth Smith, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

13702 Issued in MN

Practice address

12425 River Ridge Blvd
#200
Burnsville, MN 55337-4871

Phone

(952) 562-8500

Fax

(952) 562-8501

NPI assigned

May 14, 2008

Sex

Female

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 MN

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, 1998

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16506/brand/1/csg/1/fhir/r4

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.

• Lorenz Clinic, LLC

  • Marriage & Family Therapist
  • Victoria, MN
  • NPI 1982900510
  NPD
• Lifespan of Minnesota, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Burnsville, MN
  • NPI 1710097274
  NPD (past)

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1306013826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 GETTYSBURG AVE N",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554273816",
            "telephone_number": "763-595-9665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12425 RIVER RIDGE BLVD",
            "address_2": "#200",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374871",
            "telephone_number": "952-562-8500",
            "fax_number": "952-562-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JILL",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-14",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "13702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel C Smith, MD
• Erin M.G. Smith, PA-C
• Hanna Kristen Smith, LPCC, LADC
• Heidi Lohn Smith, DDS
• James Smith
• Josh Callum Smith
• Nakiya Smith
• Rosanna Smith, MA, LPC, LMHC
• Sean A Smith, OA
• Shakyra Smith

• Clinical Social Worker in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; 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.