NPIMap

Individual provider Active NPI

Jessie Sides

  • Addiction (Substance Use Disorder) Counselor
  • Louisville, KY
National Provider Identifier
1407571797
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Practice address
1115 Garvin PL
Louisville, KY 40203-3178
Phone
(502) 416-8783
NPI assigned
Oct 10, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X Primary

Addresses

Primary practice location

1115 Garvin PL
Louisville, KY 40203-3178

Mailing address

11118 Sandwood PL
Louisville, KY 40272-5301
Phone (502) 650-3928

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bridge the Gap Addiction and Mental Health Services Addiction (Substance Use Disorder) PastSince Oct 16, 2022 Accepting new patients
Blawesome Case Management Services Addiction (Substance Use Disorder) PastSince Oct 16, 2022 Accepting new patients
The Morton Center, Inc. Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1407571797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11118 SANDWOOD PL",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402725301",
            "telephone_number": "502-650-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 GARVIN PL",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402033178",
            "telephone_number": "502-416-8783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDES",
        "first_name": "JESSIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-10",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.