Individual provider Active NPI

Jessica Grace Sanford, LCSW

  • Clinical Social Worker
  • Richmond, IN
National Provider Identifier
1831494533
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34006645A Issued in IN
Practice address
831 Dillon Dr
Richmond, IN 47374-8048
Phone
(765) 983-8000
NPI assigned
Jan 11, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 33005855A IN
School Social Worker 1041S0200X 1082469 IN
Clinical Social Worker 1041C0700X 34006645A IN Primary

Addresses

Primary practice location

831 Dillon Dr
Richmond, IN 47374-8048

Mailing address

645 S Rogers St
Bloomington, IN 47403-2353

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240210000127 IN Practitioner - Clinical Social Worker 6002290582 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centerstone of Indiana IncGroup PAC ID 9436138427, 114 clinicians

Practice addresses (Care Compare)

720 N Marr Rd
Columbus, IN 47201-6660
Phone (812) 314-3400

809 Dillon Dr
Richmond, IN 47374-8048
Phone (765) 983-8000

831 Dillon Dr
Richmond, IN 47374-8048
Phone (765) 983-8000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33005855AINMDSocial Worker
1082469INMDSchool Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Centerstone of Indiana, Inc. CurrentSince Jan 7, 2024 Accepting new patients
Centerstone of Indiana, Inc. Current Accepting new patients

Locations

645 S Rogers St
Bloomington, IN 47403
Phone (812) 339-1691

720 N Marr Rd
Columbus, IN 47201
Phone (812) 314-3400

831 Dillon Dr
Richmond, IN 47374
Phone (765) 983-8000

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": "1294704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1831494533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 S ROGERS ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 DILLON DR",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473748048",
            "telephone_number": "765-983-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANFORD",
        "first_name": "JESSICA",
        "middle_name": "GRACE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-11",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IN",
            "license": "33005855A",
            "primary": false
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "IN",
            "license": "1082469",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34006645A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, IN

Sources for this page

Verify at the official NPI Registry.