Jill A Collum, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW16225 Issued in FL

Practice address

5325 26TH St W
Bradenton, FL 34207-3012

Phone

(941) 752-7173

NPI assigned

Mar 19, 2020

Last updated

Mar 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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

• MCCD FL Psychiatry Services PA

  dba Talkiatry

  • Psychiatry Physician
  • Jacksonville, FL
  • NPI 1659003457
  NPD
• MCR Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Parrish, FL
  • NPI 1255376000
  NPD
• MCR Health, Inc.

  dba Riverside Medical Center

  • Non-Pharmacy Dispensing Site
  • Bradenton, FL
  • NPI 1821878745
  NPD
• MCCD Psychiatry Services PLLC

  dba Talkiatry

  • Psychiatry Physician
  • New York, NY
  • NPI 1033750823
  NPD

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

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1902432164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 BANCHORY LN",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342373242",
            "telephone_number": "941-312-1529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5325 26TH ST W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342073012",
            "telephone_number": "941-752-7173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLUM",
        "first_name": "JILL",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-19",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW16225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Lauris",
            "affiliation": "N",
            "address_1": "4620 17th St",
            "city": "Sarasota",
            "state": "FL",
            "country_code": "US",
            "postal_code": "342351843",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• College Plaza Dental Center (Manatee Dental at College Plaza)
• Cory Matthew Collier, O.D.
• Holly Catherine Collins, OTR/L
• Jared Andrew Collins, D.O.
• Renee Lynn Collins, AU.D.
• Gloriana Josette Colon-Gandia, PHARMD
• Malieri Colon-Rivera, MD
• Marissa Colonna
• Kelly Colwell, LAT, ATC
• Jessica Combs, B.A.

• Clinical Social Worker in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; 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.