Jack A Register II, MSW, LCSW, LCAS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C004968 Issued in NC

Practice address

416 W Radiance Dr
Greensboro, NC 27403-1228

Phone

(336) 588-9156

NPI assigned

Dec 29, 2009

Last updated

Mar 11, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 5, 2024 through Jan 5, 2028

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Psych on Site of North Carolina, Inc

  • Clinical Social Worker
  • Houston, TX
  • NPI 1780939579
  NPD
• Trauma Healing Center LLC

  • Mental Health Counselor
  • Scottsdale, AZ
  • NPI 1184281867
  NPD (past)

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

{
    "created_epoch": "1262044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1689904401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 W RADIANCE DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274031228",
            "telephone_number": "336-588-9156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 W RADIANCE DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274031228",
            "telephone_number": "336-588-9156"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3205 Randall Pkwy Ste 105",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284032565",
            "country_code": "US",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REGISTER",
        "first_name": "JACK",
        "middle_name": "A",
        "name_suffix": "II",
        "credential": "MSW, LCSW, LCAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-12-29",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1723",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Regina Kujawa LCSW PLLC
• Reginald Center of Turn Around
• Regional Home Care, Inc.
• Regional Physicians LLC (Regional Physicians Family Medicine Adams Farm)
• Amber J Register, PA C
• Thomas E Register Jr., MD
• Scott R Rehm, DDS
• Rehobeth Family Counseling Services
• Rehobot Homecare Services
• Rehoboth Homecare Services LLC

• Clinical Social Worker in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.