Individual provider Active NPI

Tamara Jackson, LCSW

  • Clinical Social Worker
  • Hartford, CT
National Provider Identifier
1932557832
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
009426 Issued in CT
Practice address
16 Coventry St
Hartford, CT 06112-1524
Phone
(860) 714-3704
NPI assigned
Jun 1, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 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 009426 CT Primary

Addresses

Primary practice location

16 Coventry St
Hartford, CT 06112-1524

Mailing address

16 Coventry St
Hartford, CT 06112-1524

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20160928001325 CT Practitioner - Clinical Social Worker 8325335763 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford HospitalGroup PAC ID 2567366016, 1,040 clinicians

Practice addresses (Care Compare)

200 Retreat Ave
Iol Compus
Hartford, CT 06106-3310
Phone (860) 545-7500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.63 of 100Reported as group
Quality
75.35
Promoting interoperability
100
Improvement activities
40
Cost
71.44

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
009426CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
State of Connecticut CurrentSince Dec 24, 2018 Accepting new patients
State of Connecticut CurrentSince Sep 23, 2022 Accepting new patients
State of Connecticut CurrentSince Dec 24, 2018 Accepting new patients
Hartford Hospital CurrentSince Apr 13, 2019 Accepting new patients

Locations

200 Retreat Ave
Hartford, CT 06106
Phone (860) 545-7000

165 Capitol Ave
Ste 2000
Hartford, CT 06106

450 Columbus Blvd
Ste 1001
Hartford, CT 06103

500 Vine St
Hartford, CT 06112
Phone (860) 293-6400

34 Park St
North Haven, CT 06519
Phone (203) 974-7417

Interoperability endpoints

  • Direct secure messaging: tamara.jackson@xdr.hhchealthdirect.org

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 and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464739200000",
    "number": "1932557832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 COVENTRY ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061121524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 COVENTRY ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061121524",
            "telephone_number": "860-714-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TAMARA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-01",
        "last_updated": "2016-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "009426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.