Individual provider Active NPI

Jefferey David Reynolds, LCSW

  • Clinical Social Worker
  • West Palm Beach, FL
National Provider Identifier
1962565812
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW8473 Issued in FL
Practice address
1041 45TH St
West Palm Beach, FL 33407-2402
Phone
(561) 383-8000
Fax
(561) 514-1275
NPI assigned
Dec 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 SW8473 FL Primary

Addresses

Primary practice location

1041 45TH St
West Palm Beach, FL 33407-2402

Mailing address

1041 45TH St
West Palm Beach, FL 33407-2402
Phone (561) 383-8000

Other identifiers 1

IdentifierTypeStateIssuer
SW8473OtherFLSTATE LICENSED NUMBER

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20231016000627 FL Practitioner - Clinical Social Worker 2860847688 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Grow Healthcare Group PAGroup PAC ID 3476961368, 1,045 clinicians

Practice addresses (Care Compare)

16627 Pablo Island Dr
Groveland, FL 34736-9238
Phone (352) 777-9887

66 E Flagler St
Miami, FL 33130-1807
Phone (786) 244-7711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW8473FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffrey D Reynolds LLC CurrentSince Oct 4, 2023 Accepting new patients
Grow Healthcare Group PA Clinical CurrentSince Mar 5, 2024 Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 2

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": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962565812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 45TH ST",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072402",
            "telephone_number": "561-383-8000",
            "fax_number": "561-514-1275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 45TH ST",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072402",
            "telephone_number": "561-383-8000",
            "fax_number": "561-514-1275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "JEFFEREY",
        "middle_name": "DAVID",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW8473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSED NUMBER",
            "identifier": "SW8473",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

Verify at the official NPI Registry.