Individual provider Active NPI

Nikki Neudecker

  • Clinical Social Worker
  • Hamilton, OH
National Provider Identifier
1649818527
Registry record updated Feb 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.2506236 Issued in OH
Practice address
1910 Fairgrove Ave Ste E
Hamilton, OH 45011-1930
Phone
(513) 494-4679
NPI assigned
Dec 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Clinical Social Worker 1041C0700X I.2506236 OH Primary

Addresses

Primary practice location

1910 Fairgrove Ave Ste E
Hamilton, OH 45011-1930

Mailing address

1910 Fairgrove Ave Ste E
Hamilton, OH 45011-1930
Phone (513) 494-4679

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250218001525 OH Practitioner - Clinical Social Worker 9638699903 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Modern Psychiatry and Wellness LLCGroup PAC ID 6608029962, 23 clinicians

Practice addresses (Care Compare)

1910 Fairgrove Ave
Suite E
Hamilton, OH 45011-1930
Phone (513) 795-7557

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I.2506236OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Modern Psychiatry & Wellness, LLC CurrentSince Jan 21, 2025 Accepting new patients
Modern Psychiatry and Wellness LLC CurrentSince Jan 21, 2025 Accepting new patients

Locations

1910 Fairgrove Ave
Ste E
Hamilton, OH 45011
Phone (513) 299-4025

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5507/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.qualifacts.org/api/fhir/mpwhealth/r4/

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.

NPI Registry JSON

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

{
    "created_epoch": "1576022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738627200000",
    "number": "1649818527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 FAIRGROVE AVE STE E",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450111930",
            "telephone_number": "513-494-4679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 FAIRGROVE AVE STE E",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450111930",
            "telephone_number": "513-494-4679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEUDECKER",
        "first_name": "NIKKI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-11",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2506236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamilton, OH

Sources for this page

Verify at the official NPI Registry.