Individual provider Active NPI

Justin Deremo

  • Social Worker
  • Bentonville, AR
National Provider Identifier
1306418124
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
2508 SE 20TH St
Bentonville, AR 72712-4008
Phone
(479) 273-9088
NPI assigned
Jul 12, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X Primary

Addresses

Primary practice location

2508 SE 20TH St
Bentonville, AR 72712-4008

Mailing address

2400 S 48TH St
Springdale, AR 72762-6683

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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

Enrollment IDStateProvider typePAC IDDetails
I20240726003874 AR Practitioner - Clinical Social Worker 5698211563 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ozark Guidance Center, IncGroup PAC ID 7214833730, 34 clinicians
Arisa Health IncGroup PAC ID 2264853829, 65 clinicians

Practice addresses (Care Compare)

2508 SE 20TH St
Bentonville, AR 72712-4008
Phone (479) 273-9088

401 S 40TH St
Rogers, AR 72756-1802
Phone (479) 273-9088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ozark Guidance Center, Inc Social Worker CurrentSince May 18, 2024 Accepting new patients
Ozark Guidance Center, Inc CurrentSince May 18, 2024 Accepting new patients

Locations

2508 SE 20th St
Bentonville, AR 72712
Phone (479) 273-9088

1104 N College St
Huntsville, AR 72740
Phone (479) 738-2878

2400 S 48th St
Springdale, AR 72762
Phone (479) 725-5115

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1306418124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 S 48TH ST",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727626683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 SE 20TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124008",
            "telephone_number": "479-273-9088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEREMO",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.