Jeanette Shin, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LCSW90792 Issued in CA

Practice address

14625 Tyler Rd
Valley Center, CA 92082-4511

Phone

(619) 767-8022

NPI assigned

Jan 30, 2020

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

Medicare fee-for-service enrollment

Enrolled in CA, UT2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

BL Anderson Medical CorporationGroup PAC ID 5395176473, 6 clinicians

Sud Specialty Group - CaGroup PAC ID 9537534177, 519 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.

• BL Anderson Medical Corporation

  • Family Medicine Physician
  • San Diego, CA
  • NPI 1821627639
  Medicare reassignment Care Compare group NPD
• Sud Specialty Group - Ca

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238
  Medicare reassignment Care Compare group NPD
• Virtare Health Physician Services of Utah PLLC

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1164286761
  Medicare reassignment NPD

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580342400000",
    "number": "1689205494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14625 TYLER RD",
            "city": "VALLEY CENTER",
            "state": "CA",
            "postal_code": "920824511",
            "telephone_number": "619-767-8022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14625 TYLER RD",
            "city": "VALLEY CENTER",
            "state": "CA",
            "postal_code": "920824511",
            "telephone_number": "619-767-8022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "JEANETTE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-30",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "LCSW90792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Feliks Sarkisyan, RN
• Dyan M Savery, PHD
• Schauer Family Therapy
• Matthew Christian Schauer, PSY.D LMFT
• Shield Medical Supplies LLC
• H Michael Skopeck, M.D.
• Solano Diagnostics Partners, a Calif Limited Partnership
• Mican Rebecca Soriano, RN
• Diana Sourbeer, R.D.
• Donald D Swartz, D.C.

• Social Worker in Valley Center, CA
• Providers in Valley Center, CA by specialty
• Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; 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.