Individual provider Active NPI

Jeffrey Thomas Brandt, LCSW

  • Clinical Social Worker
  • Saint Louis, MO
National Provider Identifier
1952125585
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2024043792 Issued in MO
Practice address
4245 Forest Park Ave
Saint Louis, MO 63108-2810
Phone
(314) 286-4545
NPI assigned
Nov 11, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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 2024043792 MO Primary

Addresses

Primary practice location

4245 Forest Park Ave
Saint Louis, MO 63108-2810

Mailing address

4245 Forest Park Ave
Saint Louis, MO 63108-2810
Phone (314) 286-4545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20241118003523 MO Practitioner - Clinical Social Worker 5597290296 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Independence CenterGroup PAC ID 1759341852, 9 clinicians

Practice addresses (Care Compare)

4245 Forest Park Ave
Saint Louis, MO 63108-2810
Phone (314) 286-4545

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Independence Center CurrentSince Nov 18, 2024 Accepting new patients

Locations

4245 Forest Park Ave
Saint Louis, MO 63108
Phone (314) 286-4545

Organizations & group practices 1

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": "1731283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1952125585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4245 FOREST PARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082810",
            "telephone_number": "314-286-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4245 FOREST PARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082810",
            "telephone_number": "314-286-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDT",
        "first_name": "JEFFREY",
        "middle_name": "THOMAS",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-11",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2024043792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.