Mark A Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW11508 Issued in FL

Practice address

513 Menendez St
Venice, FL 34285-2233

Phone

(917) 319-1210

NPI assigned

Apr 18, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mindful Mental Health Services - FL Gulf SW LLCGroup PAC ID 9234523325, 11 clinicians

Grow Healthcare Group PAGroup PAC ID 3476961368, 1,045 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3173/brand/1/csg/1/fhir/r4

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical

  Medicare reassignment Care Compare group NPD
• Mindful Mental Health Services - FL Gulf SW LLC

  • Clinical Social Worker
  • Longboat Key, FL
  • NPI 1568121267
  Medicare reassignment Care Compare group NPD
• Harbor Inn of Venice, Inc

  • Assisted Living Facility
  • Venice, FL
  • NPI 1033550678
  NPD (past)
• Leggett Medical Group Inc

  • Adult Medicine Physician
  • Sarasota, FL
  • NPI 1659449916
  NPD (past)
• Palmetto Court Alf of Venice, Inc

  • Assisted Living Facility
  • Venice, FL
  • NPI 1992141972
  NPD (past)
• Tropical Healthcare LLC

  • Family Medicine Physician
  • Sarasota, FL
  • NPI 1720448780
  NPD (past)

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

{
    "created_epoch": "1429315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429315200000",
    "number": "1972990844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5528 CARTAGENA DR",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342333504",
            "telephone_number": "917-319-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 MENENDEZ ST",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342852233",
            "telephone_number": "917-319-1210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-18",
        "last_updated": "2015-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW11508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Island Hospitalist Group
• Issa Rehab Services Corporation
• J & J Will-Care, Inc.
• Jacaranda Family Medicine P a
• Jacaranda Pointe Anesthesia PL
• Peggy Jackson, ARNP-BC, NP-C
• Ellen Marie Jacob, LCSW, CDP
• Tara Elizabeth Jacobson, BS
• Jacqueline Z Fay OD PA
• Barbara B. Jaehne, AU.D.

• Clinical Social Worker in Venice, FL
• Providers in Venice, 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 Apr 18, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.