Jamie Lynn Pelfrey

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2304248 Issued in OH

Practice address

600 W 3Rd St
Mansfield, OH 44906-2633

Phone

(419) 522-6191

Fax

(419) 525-6723

NPI assigned

Feb 3, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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.

• Third Street Community Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • Mansfield, OH
  • NPI 1972053452
  NPD

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1730771593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W 3RD ST",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191",
            "fax_number": "419-525-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W 3RD ST",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191",
            "fax_number": "419-525-6723"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "309 Arthur St",
            "address_purpose": "LOCATION",
            "city": "Ashland",
            "state": "OH",
            "postal_code": "448053206",
            "country_code": "US",
            "telephone_number": "419-522-6191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELFREY",
        "first_name": "JAMIE",
        "middle_name": "LYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-03",
        "last_updated": "2023-07-24",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "LCDCII.161488",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2304248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0433275",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tierney Payne, LPCC
• Angela Lynn Payton, RN
• Peace of Mind Services, LLC
• Mandy Pearce
• Pedialift LLC
• Dylan Pelham
• Shanican S Pender, CDCA
• Kamrin Nicole Pendleton
• Holly Penix, NP
• Dalia Enid Perez-Gonzalez, M.D.

• Clinical Social Worker in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; 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.