Jillian Elizabeth Sammon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L4289 Issued in OR

Practice address

15 SW Colorado Ave
Suite 350
Bend, OR 97702-1150

Phone

(541) 647-0514

Fax

(541) 408-9016

NPI assigned

Jan 12, 2012

Sex

Female

Sole proprietor

Yes

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 OR

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, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Life Balance Bend LLCGroup PAC ID 0244504298, 2 clinicians

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 and National Provider Directory roles.

• Life Balance Bend LLC

  • Clinical Social Worker
  • Bend, OR
  • NPI 1669998266
  Medicare reassignment Care Compare group NPD
• Deschutes County Oregon

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bend, OR
  • NPI 1235172180
  Medicare reassignment NPD
• Deschutes County Oregon

  • Health Educator
  • Bend, OR
  • NPI 1598323040
  NPD

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414022400000",
    "number": "1316218944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 SW COLORADO AVE",
            "address_2": "SUITE 350",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021150",
            "telephone_number": "541-647-0514",
            "fax_number": "541-408-9016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 SW COLORADO AVE",
            "address_2": "SUITE 350",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021150",
            "telephone_number": "541-647-0514",
            "fax_number": "541-408-9016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMMON",
        "first_name": "JILLIAN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-12",
        "last_updated": "2014-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L4289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Salyer, PT, DPT
• Philip Dean Samaha
• Candice Samano
• Samantha Bennett LCSW Therapy LLC
• Samara Learning Center
• Travis Sammon, MSW, LCSW
• Sampson Physical Therapy, Inc
• Jonathan P Sampson, PT
• Mark E Sampson, MD
• Morag Helen, Shaw Sampson, P.T.

• Clinical Social Worker in Bend, OR
• Providers in Bend, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; 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.