Active NPI
Dolores Ann Jimerson, LCSW
- Clinical Social Worker
- Pendleton, OR
National Provider Identifier
1306090972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-624
- Practice address
- 46314 Timine Way
Pendleton, OR 97800 - Phone
- (307) 857-6685
- Fax
- (307) 857-6420
- NPI assigned
- Nov 10, 2008
- Sex
- Female
- Sole proprietor
- No
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 | LCSW-624 | WY | Primary |
Addresses
Primary practice location
46314 Timine Way
Pendleton, OR 97800
Mailing address
Yellowhawk Tribal Health Center
46314 Timine Way
Pendleton, OR 97801
Phone (307) 857-6685
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-624 | WY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wind River Health Systems | Past | Accepting new patients |
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.
-
- Federally Qualified Health Center (FQHC)
- Dubois, WY
- NPI 1700964699
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533168000000",
"number": "1306090972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "YELLOWHAWK TRIBAL HEALTH CENTER",
"address_2": "46314 TIMINE WAY",
"city": "PENDLETON",
"state": "OR",
"postal_code": "97801",
"telephone_number": "307-857-6685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "46314 TIMINE WAY",
"city": "PENDLETON",
"state": "OR",
"postal_code": "97800",
"telephone_number": "307-857-6685",
"fax_number": "307-857-6420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIMERSON",
"first_name": "DOLORES",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-10",
"last_updated": "2018-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WY",
"license": "LCSW-624",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pendleton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.