Active NPI
Jeremy Avner, LCSW
- Clinical Social Worker
- Brookfield, WI
National Provider Identifier
1306435508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 9119-123
- Practice address
- 16535 W Bluemound Rd
Brookfield, WI 53005-5936 - Phone
- (262) 999-3495
- NPI assigned
- Jan 12, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 9119-123 | WI | |
| Clinical Social Worker | 1041C0700X | 9119-123 | WI | Primary |
Addresses
Primary practice location
16535 W Bluemound Rd
Brookfield, WI 53005-5936
Mailing address
16535 W Bluemound Rd Ste 200
Brookfield, WI 53005-5906
Phone (414) 477-9517
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- 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 |
|---|---|---|---|---|
| I20241028000897 | WI | Practitioner - Clinical Social Worker | 1759814999 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Cornerstone Counseling Services Inc
Practice addresses (Care Compare)
16535 W Bluemound Rd
Suite 200
Brookfield, WI 53005-5906
Phone (262) 789-1191
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9119-123 | WI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornerstone Counseling Services, Inc | Current | Accepting new patients | |
| Family Options Counseling, LLC | Clinical | Past | Accepting new patients |
| Family Options Counseling | Clinical | Past | Accepting new patients |
Locations
4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392
16535 W Bluemound Rd
Ste 200
Brookfield, WI 53005
Phone (262) 789-0909
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Brookfield, WI
- NPI 1437322807
Clinical
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Brookfield, WI
- NPI 1164571667
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726012800000",
"number": "1306435508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16535 W BLUEMOUND RD STE 200",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530055906",
"telephone_number": "414-477-9517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16535 W BLUEMOUND RD",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530055936",
"telephone_number": "262-999-3495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVNER",
"first_name": "JEREMY",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-01-12",
"last_updated": "2024-09-11",
"certification_date": "2024-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "9119-123",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "9119-123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; 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.