Active NPI
Jessie Smith Jr.
- Clinical Social Worker
- Pinehurst, NC
National Provider Identifier
1528625282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P013389
- Practice address
- 205 Memorial Dr
Pinehurst, NC 28374-8712 - Phone
- (910) 295-6853
- NPI assigned
- May 28, 2019
- Last updated
- May 28, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | P013389 | NC | Primary |
Addresses
Primary practice location
205 Memorial Dr
Pinehurst, NC 28374-8712
Mailing address
284 Executive Park Dr Ste 100
Concord, NC 28025-1833
Phone (704) 939-1100
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, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
110 N Corcoran St
Durham, NC 27701-5015
Phone (323) 205-7088
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P013389 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Clinical | Current | Accepting new patients |
| Mental Health Specialty Group PA | Current | Accepting new patients |
Locations
3511 Shannon Rd
Fl 3
Durham, NC 27707
Phone (201) 293-7689
Organizations & group practices 2
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": "1559001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559001600000",
"number": "1528625282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "284 EXECUTIVE PARK DR STE 100",
"city": "CONCORD",
"state": "NC",
"postal_code": "280251833",
"telephone_number": "704-939-1100",
"fax_number": "704-939-1173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 MEMORIAL DR",
"city": "PINEHURST",
"state": "NC",
"postal_code": "283748712",
"telephone_number": "910-295-6853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JESSIE",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-28",
"last_updated": "2019-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P013389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pinehurst, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; 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.