Jonathan Edwin Waddell, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8906-C Issued in AR

Practice address

1210 Wolfe St
Little Rock, AR 72202-4618

Phone

(501) 364-5150

Fax

(501) 364-3966

NPI assigned

Jul 25, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pathfinder, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Jacksonville, AR
  • NPI 1326004466
  NPD
• Pathfinder, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jacksonville, AR
  • NPI 1629035043
  NPD
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD
• University of Arkansas for Medical Sciences

  • Internal Medicine Physician
  • Little Rock, AR
  • NPI 1588654016
  NPD
• University of Arkansas for Medical Sciences

  • Internal Medicine Physician
  • Little Rock, AR
  • NPI 1669534749
  NPD

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1457838187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251418",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722251418",
            "telephone_number": "501-364-1100",
            "fax_number": "501-364-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 WOLFE ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722024618",
            "telephone_number": "501-364-5150",
            "fax_number": "501-364-3966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2615 W Main St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "AR",
            "postal_code": "720764215",
            "country_code": "US",
            "telephone_number": "501-533-6302",
            "fax_number": "501-241-1466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "JONATHAN",
        "middle_name": "EDWIN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-25",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AR",
            "license": "8906-M",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "8906-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "221648795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dileepkumar Vyas, MD
• Keyur Vyas, MD
• Vanessa Ketan Vyas, MD
• W L Rutledge MD PA
• Nicholas A. Waanders, MD, PHD
• Ryan Scott Waddell, MD
• Marsha Waddill, TEACHER
• Brady Wade
• Brittany Erin Wade, APRN
• Cassandra Wade

• Clinical Social Worker in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.