Individual provider Active NPI

Alissa Hodge, LCSW

  • Clinical Social Worker
  • Jacksonville, FL
National Provider Identifier
1396191474
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW19485 Issued in FL
Practice address
12620 Beach Blvd Ste 13
Jacksonville, FL 32246-7130
Phone
(352) 639-0760
NPI assigned
May 9, 2016
Last updated
Aug 23, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW19485 FL Primary

Addresses

Primary practice location

12620 Beach Blvd Ste 13
Jacksonville, FL 32246-7130

Mailing address

12620 Beach Blvd Ste 13
Jacksonville, FL 32246-7130

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20220601001035 FL Practitioner - Clinical Social Worker 4880072941 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12620 Beach Blvd
Suite 13
Jacksonville, FL 32246-7130
Phone (904) 633-0585

Merit-based Incentive Payment System (MIPS)

Final score
59.59 of 100Reported as apm
Quality
59.93
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW19485FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians Inc Current Accepting new patients
University of Florida Jacksonville Physicians Inc CurrentSince May 31, 2022 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince May 31, 2022 Accepting new patients

Locations

12620 Beach Blvd
Ste 13
Jacksonville, FL 32246
Phone (352) 639-0760

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1396191474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12620 BEACH BLVD STE 13",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322467130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12620 BEACH BLVD STE 13",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322467130",
            "telephone_number": "352-639-0760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGE",
        "first_name": "ALISSA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-09",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW19485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.