Active NPI
Jillian Joye Modawell, LCSW
- Community Health Worker
- Oakland, CA
National Provider Identifier
1588020226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 629 Oakland Ave
Oakland, CA 94611 - Phone
- (510) 318-6137
- NPI assigned
- Jan 11, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
629 Oakland Ave
Oakland, CA 94611
Mailing address
2275 Arlington Dr
San Leandro, CA 94578-1132
Phone (510) 317-1444
Other practice location 1
724 E 2100 S Ste B
Salt Lake City, UT 84106
Phone (801) 487-0499
Other practice location 2
724 E 2100 S Ste B
Salt Lake City, UT 84106
Phone (801) 487-0499
Other names 1
- Jillian Joye Rockwood
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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LDS Family Services | Past | Accepting new patients |
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Renton, WA
- NPI 1073726485
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551139200000",
"number": "1588020226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2275 ARLINGTON DR",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945781132",
"telephone_number": "510-317-1444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "629 OAKLAND AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94611",
"telephone_number": "510-318-6137"
}
],
"practiceLocations": [
{
"address_1": "724 E 2100 S Ste B",
"address_purpose": "LOCATION",
"city": "Salt Lake City",
"state": "UT",
"postal_code": "84106",
"country_code": "US",
"telephone_number": "801-487-0499",
"fax_number": "801-487-7005",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "724 E 2100 S Ste B",
"address_purpose": "LOCATION",
"city": "Salt Lake City",
"state": "UT",
"postal_code": "84106",
"country_code": "US",
"telephone_number": "801-487-0499",
"fax_number": "801-487-7005",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MODAWELL",
"first_name": "JILLIAN",
"middle_name": "JOYE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-11",
"last_updated": "2019-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JILLIAN",
"last_name": "ROCKWOOD",
"middle_name": "JOYE",
"credential": "LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.