Individual provider Active NPI

Jennifer Lynn Moore, LCSW

  • Clinical Social Worker
  • Jacksonville, FL
National Provider Identifier
1437834280
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW23353 Issued in FL
Practice address
14540 Old Saint Augustine Rd Ste 2591
Jacksonville, FL 32258-7420
Phone
(904) 376-3800
Fax
(904) 390-7405
NPI assigned
Jun 20, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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 SW23353 FL Primary

Addresses

Primary practice location

14540 Old Saint Augustine Rd Ste 2591
Jacksonville, FL 32258-7420

Mailing address

PO Box 748519
Atlanta, GA 30374-8519
Phone (904) 376-3800

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
I20240814003300 FL Practitioner - Clinical Social Worker 1658819297 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Behavioral Health LLCGroup PAC ID 7315166394, 120 clinicians

Practice addresses (Care Compare)

14540 Old Saint Augustine Rd
Suite 2591
Jacksonville, FL 32258-7420
Phone (904) 376-3800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Behavioral Health, LLC CurrentSince Sep 1, 2024 Accepting new patients

Locations

14540 Old St Augustine Rd
Ste 2591
Jacksonville, FL 32258
Phone (904) 262-5333

820 Prudential Dr
Ste 510
Jacksonville, FL 32207

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": "1687219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1437834280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748519",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303748519",
            "telephone_number": "904-376-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14540 OLD SAINT AUGUSTINE RD STE 2591",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322587420",
            "telephone_number": "904-376-3800",
            "fax_number": "904-390-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-20",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW23353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.