Mark Jimerson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1030600 Issued in MA

Practice address

954 Ave Ponce de Leon Ste 405C
San Juan, PR 00907

Phone

(413) 636-5691

NPI assigned

Feb 1, 2007

Last updated

Aug 13, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mark Jimerson Professional name

Medicare fee-for-service enrollment

Enrolled in MA

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

Medicare enrollment (NPD)

Enrolled

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.

• Crosspoint Clinical Services, Inc

  • Clinical Social Worker
  • West Springfield, MA
  • NPI 1740534775
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534118400000",
    "number": "1649317041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 79872",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009849872",
            "telephone_number": "413-636-5691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "954 AVE PONCE DE LEON STE 405C",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00907",
            "telephone_number": "413-636-5691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMERSON",
        "first_name": "MARK",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2018-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1030600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "JIMERSON",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ricky Jimenez, MD
• Tomas Jimenez, MD
• Yalizet Jimenez
• Zulaika S Jimenez, PHARMD
• Nichsma Jimenezz, DHSC
• Juan Luis Jirau Adames, MD
• JJRG Medical Services LLC
• Jlife Med Transport, LLC.
• JLN Nephrology
• JMB Oncology PSC

• Clinical Social Worker in San Juan, PR
• Providers in San Juan, PR by specialty
• Clinical Social Worker in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.