Jessica Sansoucie, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW021262 Issued in PA

Practice address

218 Fast Ice Dr
Midland, MI 48642-6167

Phone

(989) 631-2320

NPI assigned

Jan 4, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Jessica Matczak Former name

Medicare fee-for-service enrollment

Enrolled in PA

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

Specialty

Clinical Social Worker

Education

University of Michigan Medical School, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vital Healthcare SolutionsGroup PAC ID 3274830336, 107 clinicians

Silver Willow Wellness PCGroup PAC ID 5597271577, 118 clinicians

Practice addresses (Care Compare)

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.

• Silver Willow Wellness PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Reading, PA
  • NPI 1659164697
  Medicare reassignment Care Compare group NPD
• Vital Healthcare Solutions

  • Psychiatry Physician
  • Sinking Springs, PA
  • NPI 1659736957
  Medicare reassignment Care Compare group NPD
• Che Senior Care Therapy Services PC

  • Clinical Psychologist
  • King of Prussia, PA
  • NPI 1144666496
  Medicare reassignment NPD

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

{
    "created_epoch": "1515024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609027200000",
    "number": "1578070124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 MCKEAN CT",
            "city": "NORTH WALES",
            "state": "PA",
            "postal_code": "194541081",
            "telephone_number": "609-678-8007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 FAST ICE DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486426167",
            "telephone_number": "989-631-2320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANSOUCIE",
        "first_name": "JESSICA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-04",
        "last_updated": "2020-12-27",
        "certification_date": "2020-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801102083",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801106500",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW021262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "MATCZAK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alyaa Saleh
• William T. Salfai, D.P.T.
• Susan Michelle Sallach, MD
• Carrie Sanborn
• Derek L. Sanders, DDS
• Kristin Santamour
• David Anthony Santini
• Norah A Saraya
• Ashlee Satkowiak
• Jake Sattelberg, DO

• Clinical Social Worker in Midland, MI
• Providers in Midland, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2020; 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.

Verify at the official NPI Registry.