Active NPI
Jane Hurley-Johncox, LICSW
- Clinical Social Worker
- Minneapolis, MN
National Provider Identifier
1710019567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 03303
- Practice address
- 2649 Park Ave
Minneapolis, MN 55407-1006 - Phone
- (612) 676-1604
- Fax
- (612) 379-8235
- NPI assigned
- Mar 9, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 03303 | MN | Primary |
Addresses
Primary practice location
2649 Park Ave
Minneapolis, MN 55407-1006
Mailing address
1311 Devonshire Curv
Bloomington, MN 55431-5001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130619000325 | MN | Practitioner - Clinical Social Worker | 2163661349 | Practice locations: Saint Paul, MN |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
311 Ramsey St
Saint Paul, MN 55102-2323
Phone (612) 360-3786
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03303 | MN | MD | Clinical Social Worker |
| 3303 | MN | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193702400000",
"number": "1710019567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1311 DEVONSHIRE CURV",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554315001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2649 PARK AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071006",
"telephone_number": "612-676-1604",
"fax_number": "612-379-8235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HURLEY-JOHNCOX",
"first_name": "JANE",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-09",
"last_updated": "2007-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "03303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; 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.