Individual provider Active NPI

Jacquelyn Renae Thompson, LICSW, LADC

  • Clinical Social Worker
  • Omaha, NE
National Provider Identifier
1780879916
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1086 Issued in NE
Practice address
1941 S 42ND St Ste 328
Omaha, NE 68105-2943
Phone
(402) 614-8444
NPI assigned
Sep 11, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 1137 NE
Social Worker 104100000X
Clinical Social Worker 1041C0700X 1336 NE
Clinical Social Worker 1041C0700X 1086 NE Primary

Addresses

Primary practice location

1941 S 42ND St Ste 328
Omaha, NE 68105-2943

Mailing address

1941 S 42ND St Ste 328
Omaha, NE 68105-2943
Phone (402) 614-8444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20071010000627 NE Practitioner - Clinical Social Worker 3072609767 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1137NEMDAddiction (Substance Use Disorder) Counselor
1336NEMDClinical Social Worker
1086NEMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of Ohio, Inc. Clinical CurrentSince Nov 9, 2024 Accepting new patients
Optum Behavioral Care of Ohio, Inc CurrentSince Nov 9, 2024 Accepting new patients

Locations

11000 Optum Cir
Eden Prairie, MN 55344
Phone (888) 445-8745

230 E 22nd St
Ste 4
Fremont, NE 68025
Phone (402) 727-1592

230 E 22nd St
Ste 5
Fremont, NE 68025
Phone (402) 356-3332

1941 S 42nd St
Ste 328
Omaha, NE 68105
Phone (402) 614-8444

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1780879916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 S 42ND ST STE 328",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681052943",
            "telephone_number": "402-614-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 S 42ND ST STE 328",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681052943",
            "telephone_number": "402-614-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "JACQUELYN",
        "middle_name": "RENAE",
        "credential": "LICSW, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-11",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NE",
            "license": "1137",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NE",
            "license": "1336",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NE",
            "license": "1086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.