Active NPI
Jeffrey Allen Schurgast, LPCC-S, LICDC
- Professional Counselor
- Middletown, OH
National Provider Identifier
1639563844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E.1100455.SUPV
- Practice address
- 4464 S Dixie Hwy
Middletown, OH 45005-5464 - Phone
- (513) 649-8008
- Fax
- (513) 649-8004
- NPI assigned
- Mar 25, 2015
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LICDC.141206 | OH | |
| Professional Counselor | 101YP2500X | E.1100455.SUPV | OH | Primary |
| Mental Health Counselor | 101YM0800X | E.1100455.SUPV | OH |
Addresses
Primary practice location
4464 S Dixie Hwy
Middletown, OH 45005-5464
Mailing address
4464 S Dixie Hwy
Middletown, OH 45005-5464
Phone (513) 649-8008
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0074861 | Other | OH | MEDICAID LEGACY NUMBER CHEMICAL DEPENDENCY |
| 0074946 | Other | OH | MEDICAID LEGACY NUMBER MENTAL HEALTH |
| 01-0693 | Other | OH | CARF CERTIFICATION |
| H130910 | Other | OH | MEDICARE GROUP PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- 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
- Mental Health Counselor
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
4464 S Dixie Hwy
Middletown, OH 45005-5464
Phone (513) 649-8008
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LICDC.141206 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| E.1100455.SUPV | OH | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Access Counseling Services LLC | Addiction (Substance Use Disorder) | Current | Accepting new patients |
| Access Counseling Services, LLC | Addiction (Substance Use Disorder) | Past | Accepting new patients |
Locations
4464 S Dixie Hwy
Middletown, OH 45005
Phone 5136498008 ext. 22
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 and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Middletown, OH
- NPI 1073884524
Addiction (Substance Use Disorder)
-
- Community/Behavioral Health Agency
- Middletown, OH
- NPI 1245583673
Addiction (Substance Use Disorder)
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486598400000",
"number": "1639563844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4464 S DIXIE HWY",
"city": "MIDDLETOWN",
"state": "OH",
"postal_code": "450055464",
"telephone_number": "513-649-8008",
"fax_number": "513-649-8004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4464 S DIXIE HWY",
"city": "MIDDLETOWN",
"state": "OH",
"postal_code": "450055464",
"telephone_number": "513-649-8008",
"fax_number": "513-649-8004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHURGAST",
"first_name": "JEFFREY",
"middle_name": "ALLEN",
"credential": "LPCC-S, LICDC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-25",
"last_updated": "2017-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "LICDC.141206",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E.1100455.SUPV",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OH",
"license": "E.1100455.SUPV",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID LEGACY NUMBER CHEMICAL DEPENDENCY",
"identifier": "0074861",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID LEGACY NUMBER MENTAL HEALTH",
"identifier": "0074946",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARF CERTIFICATION",
"identifier": "01-0693",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PTAN",
"identifier": "H130910",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Middletown, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; 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.