Individual provider Active NPI

Kelland Jay Brewer, CSW

  • Clinical Social Worker
  • Moab, UT
National Provider Identifier
1750869863
Registry record updated Aug 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
10834446-3501 Issued in UT
Practice address
46 E. 300 N.
Moab, UT 84532
Phone
(435) 259-6131
Fax
(435) 259-5369
NPI assigned
Jul 31, 2018
Last updated
Aug 18, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 10834446-3502 UT
Clinical Social Worker 1041C0700X 10834446-3501 UT Primary

Addresses

Primary practice location

46 E. 300 N.
Moab, UT 84532

Mailing address

PO Box 867
Price, UT 84501-0867
Phone (435) 637-7200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20200813003393 UT Practitioner - Clinical Social Worker 7911323480 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

198 E Ctr St
Moab, UT 84532-2430
Phone (435) 259-6131

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10834446-3502UTMDSocial Worker
10834446-3501UTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Four Corners Community Behavioral Health Inc CurrentSince May 20, 2020 Accepting new patients
Four Corners Community Behavioral Health, Inc. CurrentSince May 20, 2020 Accepting new patients

Locations

198 E Center St
Moab, UT 84532
Phone (435) 259-2432

690 E Main St
Price, UT 84501
Phone (435) 637-2358

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1750869863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 867",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845010867",
            "telephone_number": "435-637-7200",
            "fax_number": "435-637-2377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 E. 300 N.",
            "city": "MOAB",
            "state": "UT",
            "postal_code": "84532",
            "telephone_number": "435-259-6131",
            "fax_number": "435-259-5369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREWER",
        "first_name": "KELLAND",
        "middle_name": "JAY",
        "credential": "CSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-31",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "10834446-3502",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "10834446-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moab, UT

Sources for this page

Verify at the official NPI Registry.