Kieran L. Jackson, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

850 N Harrison St
Warsaw, IN 46580-3163

Phone

(574) 267-7169

Fax

(574) 269-3995

NPI assigned

Jun 27, 2017

Last updated

Aug 21, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bowen Health Inc

  dba Otis R Bowen Center

  • Adult Mental Health Clinic/Center
  • Warsaw, IN
  • NPI 1639172810
  Medicare reassignment NPD
• Bowen Health Inc

  • Federally Qualified Health Center (FQHC)
  • Fort Wayne, IN
  • NPI 1023668183
  NPD
• Bowen Health, Inc.

  • Psychiatric Hospital Unit
  • Warsaw, IN
  • NPI 1760521140
  NPD (past)

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597968000000",
    "number": "1821518226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 E JEFFERSON ST",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803880",
            "telephone_number": "574-267-7169",
            "fax_number": "574-269-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 N HARRISON ST",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803163",
            "telephone_number": "574-267-7169",
            "fax_number": "574-269-3995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIERAN",
        "middle_name": "L.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-27",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nilanka Rurangi Silva Inasi, MA
• Indiana Physical Therapy, Inc.
• Dominique Islas
• Jace Medical LLC
• Elizabeth Ann Jackson, COTA
• Andrew Paul Jankowski
• Jansen Orthopaedic Clinic, LLC
• Leo Dean Jansen, M.D.
• Jeffrey Hartzell MD PC (Indiana Sports Medicine and Orthopaedics)
• Dwight Douglas Jeffreys, RPH

• Clinical Social Worker in Warsaw, IN
• Providers in Warsaw, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; 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.