Active NPI
Jan Roll-Mederos, M.S.W.
- Clinical Social Worker
- Jamaica Plain, MA
National Provider Identifier
1750341996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 105053
- Practice address
- 86 Forest Hills St
Jamaica Plain, MA 02130-2935 - Phone
- (617) 524-2415
- Fax
- (617) 524-7717
- NPI assigned
- Mar 23, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 105053 | MA | Primary |
Addresses
Primary practice location
86 Forest Hills St
Jamaica Plain, MA 02130-2935
Mailing address
86 Forest Hills St
Jamaica Plain, MA 02130-2935
Phone (617) 524-2415
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1852094 | Medicaid | MA | |
| 1891260 | Medicaid | MA | |
| P04867 | Other | MA | BLUE CROSS BLUE SHIELD MA |
| 110286000 | Other | MA | MAGELLAN BEHAVIORAL HEALT |
| 1019670 | Other | MA | NEIGHBORHOOD HEALTH PLAN |
Medicare participation
Medicare enrollment files- 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105053 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354665600000",
"number": "1750341996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "86 FOREST HILLS ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021302935",
"telephone_number": "617-524-2415",
"fax_number": "617-524-7717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "86 FOREST HILLS ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021302935",
"telephone_number": "617-524-2415",
"fax_number": "617-524-7717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLL-MEDEROS",
"first_name": "JAN",
"name_prefix": "Ms.",
"credential": "M.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-23",
"last_updated": "2012-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "105053",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1852094",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1891260",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD MA",
"identifier": "P04867",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN BEHAVIORAL HEALT",
"identifier": "110286000",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEALTH PLAN",
"identifier": "1019670",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamaica Plain, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; 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.