Jesika M Gomez, MSM, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2021034285 Issued in MO

Practice address

804 S Natalie Ave
Springfield, MO 65802-9702

Phone

(417) 207-9039

NPI assigned

Jun 13, 2019

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 2

Medicare fee-for-service enrollment

Enrolled in MO

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

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.

• Eagles Wings Counseling LLC

  • Clinical Social Worker
  • Springfield, MO
  • NPI 1063280899
  NPD Authorized official
• Mercy Clinic Springfield Communities

  • Rural Health Clinic/Center
  • Willow Springs, MO
  • NPI 1972771657
  Medicare reassignment
• Mercy Clinic Springfield Communities

  • Family Medicine Physician
  • Hollister, MO
  • NPI 1053350454
  NPD

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1750940649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 S NATALIE AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658029702",
            "telephone_number": "417-207-9039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 S NATALIE AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658029702",
            "telephone_number": "417-207-9039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3231 S National Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658077304",
            "country_code": "US",
            "telephone_number": "417-820-3128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "JESIKA",
        "middle_name": "M",
        "credential": "MSM, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-13",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MO",
            "license": "2019014457",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2021034285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "490074371",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14467421",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Juanita Nicole Golden-Allen, APN
• Erin Golden, PSYD
• Nora C Goller, MS CF-SLP
• Evgenia I Golubchenko, PLPC
• Victor Ivan Gomez Lorenzo, MD
• Savannah Gomez
• Daphne Gonce
• Anganile E Gondwe, FNP
• Gonyaw Chiropractic
• Elizabeth A Gonyaw, D.C.

• Clinical Social Worker in Springfield, MO
• Providers in Springfield, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; 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.