Active NPI
Cassidy Redshaw
- Mental Health Counselor
- Jacksonville, FL
National Provider Identifier
1639883168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 5300 San Juan Ave
Jacksonville, FL 32210-3142 - Phone
- (904) 738-8579
- NPI assigned
- Jan 10, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
5300 San Juan Ave
Jacksonville, FL 32210-3142
Mailing address
3867 Buckskin TRL E
Jacksonville, FL 32277-2229
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cassidy@fccsupportservice.com | Direct |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Suite 16253
Jacksonville, FL 32245
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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.
-
- Community/Behavioral Health Agency
- Jacksonville, FL
- NPI 1144991134
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1673308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673308800000",
"number": "1639883168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3867 BUCKSKIN TRL E",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322772229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5300 SAN JUAN AVE",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322103142",
"telephone_number": "904-738-8579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDSHAW",
"first_name": "CASSIDY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-10",
"last_updated": "2023-01-10",
"certification_date": "2023-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cassidy@fccsupportservice.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "5300 San Juan Ave",
"city": "Jacksonville",
"state": "FL",
"country_code": "US",
"postal_code": "322103142",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; 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.