Individual provider Active NPI

Kimberly Jones Dekan, LCSW

  • Clinical Social Worker
  • Raleigh, NC
National Provider Identifier
1902238108
Registry record updated Dec 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C009701 Issued in NC
Practice address
3937 Western Blvd
Raleigh, NC 27606-1936
Phone
(919) 821-0790
Fax
(919) 518-9476
NPI assigned
Jul 30, 2013
Last updated
Dec 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C009701 NC Primary

Addresses

Primary practice location

3937 Western Blvd
Raleigh, NC 27606-1936

Mailing address

3937 Western Blvd
Raleigh, NC 27606-1936
Phone (919) 821-0790

Other identifiers 1

IdentifierTypeStateIssuer
P008046OtherNCSTATE LICENSE

Other names 1

  • Kimberly Danielle Jones Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20160317001374 NC Practitioner - Clinical Social Worker 0244536233 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WakemedGroup PAC ID 7315937612, 72 clinicians

Practice addresses (Care Compare)

1900 Kildaire Farm Rd
Cary, NC 27518-6616
Phone (919) 350-2300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C009701NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Wakemed Clinical CurrentSince Jul 1, 2018 Accepting new patients
Wake Medical Laboratory Consultants Inc Current Accepting new patients
Wakemed CurrentSince Jul 1, 2018 Accepting new patients
Raleigh Pathology Laboratory Associates PA Current Accepting new patients

Locations

120 Healthplex Way
Apex, NC 27502
Phone (919) 235-6525

1900 Kildaire Farm Rd
Cary, NC 27518
Phone (919) 350-2300

400 US 70 Hwy E
Garner, NC 27529
Phone (919) 235-6400

10000 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1300

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

8001 T W Alexander Dr
Raleigh, NC 27617
Phone (919) 350-0953

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1375142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482105600000",
    "number": "1902238108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3937 WESTERN BLVD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276061936",
            "telephone_number": "919-821-0790",
            "fax_number": "919-518-9476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3937 WESTERN BLVD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276061936",
            "telephone_number": "919-821-0790",
            "fax_number": "919-518-9476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEKAN",
        "first_name": "KIMBERLY",
        "middle_name": "JONES",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-30",
        "last_updated": "2016-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C009701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "P008046",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "JONES",
            "middle_name": "DANIELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.