Active NPI
Jane Polkinghorne, ASW
- Mental Health Counselor
- Lemon Grove, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- ASW59518
- Practice address
- 3434 Grove St
Lemon Grove, CA 91945-1812 - Phone
- (619) 281-3706
- NPI assigned
- Oct 7, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | ASW59518 | CA | Primary |
Addresses
Primary practice location
3434 Grove St
Lemon Grove, CA 91945-1812
Mailing address
3434 Grove St
Lemon Grove, CA 91945-1812
Phone (619) 281-3706
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3545 Whitehall Park Dr
Suite 300
Charlotte, NC 28273-4179
Phone (980) 302-8850
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW59518 | CA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forsyth Memorial Hospital, Inc. | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Current | Accepting new patients | |
| Forsyth Memorial Hospital, Inc. | Current | Accepting new patients | |
| Forsyth Memorial Hospital Inc | Current | Accepting new patients |
Locations
200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424
1900 Randolph Rd
Ste 800
Charlotte, NC 28207
Phone (704) 941-4171
3545 Whitehall Park Dr
Ste 300
Charlotte, NC 28273
Phone (704) 316-6187
6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473
13815 Professional Center Dr
Ste 100
Huntersville, NC 28078
Phone (704) 316-2050
5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441
175 Kimel Park Dr
Ste 100
Winston Salem, NC 27103
Phone (336) 277-1811
2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300
Organizations & group practices 6
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.
-
- Neurology with Special Qualifications in Child Neurology Physician
- Charlotte, NC
- NPI 1366409492
-
- Family Medicine Physician
- Winston Salem, NC
- NPI 1104548874
-
- Psychiatry Physician
- Winston Salem, NC
- NPI 1508350349
-
- Cardiovascular Disease Physician
- Winston Salem, NC
- NPI 1932935475
-
- Obstetrics & Gynecology Physician
- Matthews, NC
- NPI 1386506137
-
- Psychiatry Physician
- Charlotte, NC
- NPI 1588610471
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433980800000",
"number": "1407130479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3434 GROVE ST",
"city": "LEMON GROVE",
"state": "CA",
"postal_code": "919451812",
"telephone_number": "619-281-3706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3434 GROVE ST",
"city": "LEMON GROVE",
"state": "CA",
"postal_code": "919451812",
"telephone_number": "619-281-3706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLKINGHORNE",
"first_name": "JANE",
"credential": "ASW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-07",
"last_updated": "2015-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "ASW59518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lemon Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; 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.