Individual provider Active NPI

Vernon Thomas Jaques, LCSW

  • Clinical Social Worker
  • Gallup, NM
National Provider Identifier
1689746554
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C-10278 Issued in NM
Practice address
516 E. Nizhoni Blvd
Gallup, NM 87301-5748
Phone
(505) 722-1000
Fax
(928) 697-4189
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C-10278 NM Primary
Clinical Social Worker 1041C0700X M-04628 NM

Addresses

Primary practice location

516 E. Nizhoni Blvd
Gallup, NM 87301-5748

Mailing address

PO Box 1337
Gallup, NM 87305-1337
Phone (505) 722-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20051116000823 TX Practitioner - Clinical Social Worker 5294754461 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DHHS,PHS,Naihs, Gallup Indian Medical CenterGroup PAC ID 3173436409, 179 clinicians

Practice addresses (Care Compare)

516 E Nizhoni Blvd
Gallup, NM 87301-5748
Phone (505) 722-1000

Hospital & facility affiliations

  • Gallup Indian Medical Center Hospital, Gallup, NM, CCN 320061

Merit-based Incentive Payment System (MIPS)

Final score
78.18 of 100Reported as group
Quality
61.12
Improvement activities
40
Cost
81.87

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C-10278NMMDClinical Social Worker
M-04628NMMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS,PHS,Naihs, Gallup Indian Medical Center CurrentSince Mar 4, 2018 Accepting new patients
Kayenta Alternative Rural Hospital CurrentSince May 28, 2019 Accepting new patients
DHHS PHS Naihs Fort Defiance Hospital Past Accepting new patients
Kayenta Alternative Rural Hospital Past Accepting new patients

Locations

516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326

Organizations & group practices 4

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": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1689746554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1337",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873051337",
            "telephone_number": "505-722-1000",
            "fax_number": "928-697-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 E. NIZHONI BLVD",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015748",
            "telephone_number": "505-722-1000",
            "fax_number": "928-697-4189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAQUES",
        "first_name": "VERNON",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-10278",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "M-04628",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gallup, NM

Sources for this page

Verify at the official NPI Registry.