Individual provider Active NPI

Jodie Olga Ball, LCSW, LAC

  • Clinical Social Worker
  • Ft. Collins, CO
National Provider Identifier
1356850846
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LSW.09926250 Issued in CO
Practice address
4115 Boardwalk Drive
Ft. Collins, CO 80525
Phone
(970) 493-4580
Fax
(970) 797-2859
NPI assigned
Sep 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X LSW.0009921707 CO
Clinical Social Worker 1041C0700X LSW.09926250 CO Primary

Addresses

Primary practice location

4115 Boardwalk Drive
Ft. Collins, CO 80525

Mailing address

4115 Boardwalk Drive
Ft. Collins, CO 80525
Phone (970) 493-4580

Other identifiers 1

IdentifierTypeStateIssuer
9000154372MedicaidCO

Other names 1

  • Ms. Jodie Olga Hight Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20201007000824 CO Practitioner - Clinical Social Worker 2961821178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neurofeedback Clinic of Northern Colorado LLCGroup PAC ID 6406162353, 16 clinicians

Practice addresses (Care Compare)

4115 Boardwalk Dr
Unit 100
Fort Collins, CO 80525-5945
Phone (970) 493-4580

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LSW.0009921707COMDSocial Worker
LSW.09926250COMDClinical Social Worker

Organizations & group practices 1

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": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1356850846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 BOARDWALK DRIVE",
            "city": "FT. COLLINS",
            "state": "CO",
            "postal_code": "80525",
            "telephone_number": "970-493-4580",
            "fax_number": "970-797-2859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 BOARDWALK DRIVE",
            "city": "FT. COLLINS",
            "state": "CO",
            "postal_code": "80525",
            "telephone_number": "970-493-4580",
            "fax_number": "970-797-2859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALL",
        "first_name": "JODIE",
        "middle_name": "OLGA",
        "name_prefix": "Mrs.",
        "credential": "LCSW, LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-27",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CO",
            "license": "LSW.0009921707",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "LSW.09926250",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000154372",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JODIE",
            "last_name": "HIGHT",
            "middle_name": "OLGA",
            "prefix": "MS.",
            "credential": "LCSW, LAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ft. Collins, CO

Sources for this page

Verify at the official NPI Registry.