Individual provider Active NPI

Jarred M Duellman, MSW

  • Social Worker
  • Eau Claire, WI
National Provider Identifier
1841264090
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
7108 Issued in WI
Practice address
1400 Bellinger St
Eau Claire, WI 54703-5222
Phone
(715) 838-5222
NPI assigned
Feb 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 7108 WI
Social Worker 104100000X 7108 WI Primary

Addresses

Primary practice location

1400 Bellinger St
Eau Claire, WI 54703-5222

Mailing address

PO Box 1510
Eau Claire, WI 54702-1510
Phone (715) 838-5222

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jduellman21982@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20040730001130 WI Practitioner - Clinical Social Worker 5092785436 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mayo Clinic Health System-Northwest Wisconsin Region IncGroup PAC ID 4385553627, 797 clinicians

Practice addresses (Care Compare)

1400 Bellinger St
Eau Claire, WI 54703-5222
Phone (715) 838-5222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7108WIMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Jan 10, 2017 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Jan 10, 2017 Accepting new patients
Omne Clinic Inc Past Accepting new patients

Locations

733 W Clairemont Ave
Eau Claire, WI 54701
Phone (715) 838-3806

1400 Bellinger St
Eau Claire, WI 54703
Phone (715) 838-3311

2409 Stout Rd
Menomonie, WI 54751
Phone (715) 231-3937

Interoperability endpoints

  • Direct secure messaging: jduellman21982@ehrdirect.mayoclinicmsg.org

Organizations & group practices 3

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": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613952000000",
    "number": "1841264090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547021510",
            "telephone_number": "715-838-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BELLINGER ST",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547035222",
            "telephone_number": "715-838-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUELLMAN",
        "first_name": "JARRED",
        "middle_name": "M",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7108",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "7108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jduellman21982@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "1400 Bellinger St",
            "city": "Eau Claire",
            "state": "WI",
            "country_code": "US",
            "postal_code": "547035222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Eau Claire, WI

Sources for this page

Verify at the official NPI Registry.