Jeanie Ray Shade, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12579-C Issued in AR

Practice address

1001 SE 28TH St
Bentonville, AR 72712-3205

Phone

(479) 403-2915

NPI assigned

Aug 25, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Clinical Social Worker

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brightside Medical of Michigan PCGroup PAC ID 9830562776, 90 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Brightside Medical of Michigan PC

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1144800350

  AR

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1659048809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 NANTUCKET DR",
            "city": "BELLA VISTA",
            "state": "AR",
            "postal_code": "727158178",
            "telephone_number": "208-749-4323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SE 28TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123205",
            "telephone_number": "479-403-2915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADE",
        "first_name": "JEANIE",
        "middle_name": "RAY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-25",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "12579-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Sego, SLPA
• Reginee Dion Sephus
• Serc Rehabilitation Partners LLC
• Emily Settler, RD, LD
• John Sevier, LPC
• Karl David Shade
• Kathryn M Shaffer, LPC
• Shamsul Alam MD PA (The Kidney Clinic)
• Tiffany Lynn Shanahan, NP-C
• Shanna M. Molina MD PLLC

• Clinical Social Worker in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.

Verify at the official NPI Registry.