Jon Wayne Eccleston II, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C004734 Issued in NC

Practice address

124 Unionville Indian TRL Rd W
Suite A1
Indian Trail, NC 28079-5591

Phone

(704) 608-0445

Fax

(704) 821-9337

NPI assigned

Sep 28, 2006

Last updated

Sep 21, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

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, 2000

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carolina's Therapy Solutions

  • Community/Behavioral Health Agency
  • Indian Trail, NC
  • NPI 1740463439
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316563200000",
    "number": "1306937750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 UNIONVILLE INDIAN TRL RD W",
            "address_2": "SUITE A1",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280795591",
            "telephone_number": "704-608-0445",
            "fax_number": "704-821-9337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 UNIONVILLE INDIAN TRL RD W",
            "address_2": "SUITE A1",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280795591",
            "telephone_number": "704-608-0445",
            "fax_number": "704-821-9337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECCLESTON",
        "first_name": "JON",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2011-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC CLINICAL SOCIAL WORK",
            "identifier": "C004734",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600913",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Camille Edmond, RPH
• Electrostim Medical Services, Inc. (Emsi)
• Christy S Engle, PT
• Erta Ale LLC
• Allison Bell Eudy, PT

• Clinical Social Worker in Indian Trail, NC
• Providers in Indian Trail, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; 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.