Individual provider Active NPI

Joseph Bermudez

  • Clinical Social Worker
  • Ontario, CA
National Provider Identifier
1659670271
Registry record updated Feb 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW74849 Issued in CA
Practice address
2940 Inland Empire Blvd
Ontario, CA 91764-4898
Phone
(909) 458-1517
NPI assigned
Mar 22, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 20, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X LCSW74849 CA Primary

Addresses

Primary practice location

2940 Inland Empire Blvd
Ontario, CA 91764-4898

Mailing address

2940 Inland Empire Blvd
Ontario, CA 91764

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20200213000256 CA Practitioner - Clinical Social Worker 0042646929 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW74849CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana University Health Ball Memorial Hospital, Inc. Past Accepting new patients
Community Health Systems, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: joseph.bermudez.p1@direct.chsica.nextgenshare.com

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": "1300752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519084800000",
    "number": "1659670271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 INLAND EMPIRE BLVD",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "91764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 INLAND EMPIRE BLVD",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917644898",
            "telephone_number": "909-458-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERMUDEZ",
        "first_name": "JOSEPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-03-22",
        "last_updated": "2018-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW74849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

Verify at the official NPI Registry.