Jonathan Keith Wall, MSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

ISW12721 Issued in FL

Practice address

114 Date Palm Dr
Jupiter, FL 33458-2802

Phone

(919) 612-9840

NPI assigned

May 1, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mindy Staum LCSW PAGroup PAC ID 5890952998, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• Mindy Staum, LCSW, P.a

  • Clinical Social Worker
  • Coral Springs, FL
  • NPI 1083922561

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1682899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1891483590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 DATE PALM DR",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334582802",
            "telephone_number": "919-612-9840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 DATE PALM DR",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334582802",
            "telephone_number": "919-612-9840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "JONATHAN",
        "middle_name": "KEITH",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-01",
        "last_updated": "2023-05-01",
        "certification_date": "2023-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "ISW12721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Walker, ARNP
• Deanna Walker, MOTR/L
• Heather Leigh Walker, APRN
• Jennifer Marie Walker, M.A. CCC-SLP
• Kurt E Walker, AU.D.
• Robyn Lynn Wallace, PH.D
• Shawn Waller, DPT
• Bradley J Wallrath, PA
• Maryann Walsh, R.D.
• Wanuck, Hier & Associates

• Mental Health Counselor in Jupiter, FL
• Providers in Jupiter, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; 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.

Verify at the official NPI Registry.