Active NPI
Katie M Miller Jacobus
- Clinical Social Worker
- East Dennis, MA
National Provider Identifier
1801939426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 115195
- Practice address
- 1070 Route 134
East Dennis, MA 02641 - Phone
- (508) 385-7474
- NPI assigned
- Feb 14, 2007
- Last updated
- Jan 8, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 213313 | MA | |
| Clinical Social Worker | 1041C0700X | 115195 | MA | Primary |
Addresses
Primary practice location
1070 Route 134
East Dennis, MA 02641
Mailing address
Pobox 1094
Brewster, MA 02631
Phone (508) 237-6642
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091130000579 | MA | Practitioner - Clinical Social Worker | 0840339198 | Practice locations: South Dennis, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1070 Route 134
South Dennis, MA 02660-2000
Phone (508) 385-7474
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115195 | MA | MD | Clinical Social Worker |
| 213313 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262908800000",
"number": "1801939426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "POBOX 1094",
"city": "BREWSTER",
"state": "MA",
"postal_code": "02631",
"telephone_number": "508-237-6642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1070 ROUTE 134",
"city": "EAST DENNIS",
"state": "MA",
"postal_code": "02641",
"telephone_number": "508-385-7474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER JACOBUS",
"first_name": "KATIE",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-14",
"last_updated": "2010-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "213313",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "115195",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Dennis, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2010; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.