Jessica Mt Dubose, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60205596 Issued in WA

Practice address

1200 SW 27TH St
Renton, WA 98057-2603

Phone

(206) 630-1680

NPI assigned

Oct 6, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jessica M Thomas Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jdubose167222@ghc.direct-ci.net

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.

• Kaiser Foundation Health Plan of Washington

  • Multi-Specialty Clinic/Center
  • Seattle, WA
  • NPI 1396810701
  Medicare reassignment NPD
• The Association of University Physicians

  dba University of Washington Physicians

  • Anesthesiology Physician
  • Seattle, WA
  • NPI 1023041159
  Medicare reassignment NPD
• Kaiser Foundation Health Plan of Washington

  • Multi-Specialty Clinic/Center
  • Renton, WA
  • NPI 1124264577
  NPD
• Kaiser Foundation Health Plan of Washington

  dba Everett Medical Center

  • Multi-Specialty Clinic/Center
  • Everett, WA
  • NPI 1386935351
  NPD

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

{
    "created_epoch": "1444089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1659741304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SW 27TH ST",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980572603",
            "telephone_number": "206-630-1680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SW 27TH ST",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980572603",
            "telephone_number": "206-630-1680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Broadway",
            "address_2": "Suite 2075",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981222499",
            "country_code": "US",
            "telephone_number": "206-520-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUBOSE",
        "first_name": "JESSICA",
        "middle_name": "MT",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-06",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60205596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1200 SW 27th St",
            "city": "Renton",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980572603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "THOMAS",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dr. Mark McDaniels
• Dr. Michelle G. Chang DMD PLLC
• Vera P Dragonchuk, M.A.
• Kirby A Drawbaugh, RPH
• Michelle Drones, ARNP
• Shannon Duffy, APRN
• Wendy Nadia Duffy, RPH
• Samantha Louise Dull, M.S
• Jenny Duong-Bui, DPT
• Minh Duong

• Clinical Social Worker in Renton, WA
• Providers in Renton, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; 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.