Jacob Porter, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

28211 Issued in MN

Practice address

2312 S 6TH St
Minneapolis, MN 55454-1336

Phone

(612) 672-6999

NPI assigned

Feb 11, 2022

Last updated

Feb 11, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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 MN

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

Medicare enrollment (NPD)

Enrolled

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.

• Fairview Express Care

  dba M Health Fairview Recovery Clinic

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  Medicare reassignment NPD
• Fairview Express Care

  • General Practice Physician
  • Edina, MN
  • NPI 1831707207
  NPD
• Fairview Express Care

  • Family Medicine Physician
  • Princeton, MN
  • NPI 1952779266
  NPD

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

{
    "created_epoch": "1644537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1326792946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2641 34TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554061735",
            "telephone_number": "319-415-5464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2312 S 6TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541336",
            "telephone_number": "612-672-6999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "JACOB",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-11",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "28211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Portages Health LLC
• Paul J Portenlanger, CRNA
• Angela Marie Porter
• Danielle Porter, DNP
• Gretchen Evanne Porter, RN, CNP, LAC
• Mayrose Ruth Porter
• Mercedes Porter
• Tondolaya Jaclene Porter
• Ana Lucia Portilla Fernandez, MD
• Portlight Mental Health

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.