Individual provider Active NPI

Jake Swanson, LCSW

  • Clinical Social Worker
  • Melbourne, FL
National Provider Identifier
1609480383
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW20648 Issued in FL
Practice address
3932 W Eau Gallie Blvd Ste 101
Melbourne, FL 32934-3283
Phone
(321) 207-8495
Fax
(709) 400-7957
NPI assigned
Sep 1, 2020
Last updated
Apr 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

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 SW20648 FL Primary

Addresses

Primary practice location

3932 W Eau Gallie Blvd Ste 101
Melbourne, FL 32934-3283

Mailing address

3932 W Eau Gallie Blvd Ste 101
Melbourne, FL 32934-3283
Phone (321) 207-8495

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
I20240717002955 FL Practitioner - Clinical Social Worker 6103361852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Balanced Wellbeing LLCGroup PAC ID 5193021848, 228 clinicians

Practice addresses (Care Compare)

3200 SW 34TH Ave
Suite 701
Ocala, FL 34474-8443
Phone (877) 779-2429

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW20648FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Balanced Wellbeing LLC Clinical CurrentSince Jul 1, 2024 Accepting new patients

Locations

3200 SW 34th Ave
Ste 701
Ocala, FL 34474
Phone (354) 445-1200

Networks

  • Freedom Health HMO Network

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, 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": "1598918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1609480383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3932 W EAU GALLIE BLVD STE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329343283",
            "telephone_number": "321-207-8495",
            "fax_number": "709-400-7957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3932 W EAU GALLIE BLVD STE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329343283",
            "telephone_number": "321-207-8495",
            "fax_number": "709-400-7957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWANSON",
        "first_name": "JAKE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-01",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW20648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.