Jeff William Shively, LICSW in Plymouth, MN - Medicare Social Worker Provider

Jeff William Shively, LICSW is a medicare enrolled "Social Worker - Clinical" provider in Plymouth, Minnesota. His current practice location is 12805 Highway 55, Suite 200, Plymouth, Minnesota. You can reach out to his office (for appointments etc.) via phone at (612) 723-0408.

Jeff William Shively is licensed to practice in Minnesota (license number 18053) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1376782961.

Contact Information

	Jeff William Shively, LICSW
	12805 Highway 55, Suite 200, Plymouth, MN 55441-3859
	(612) 723-0408
	(763) 210-5379

Map and Direction

Healthcare Provider's Profile

Full Name	Jeff William Shively
Gender	Male
Speciality	Social Worker - Clinical
Location	12805 Highway 55, Plymouth, Minnesota
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1376782961
Provider Enumeration Date: 02/05/2009
Last Update Date: 03/05/2013

Medicare PECOS Information:

PECOS PAC ID: 3476610049
Enrollment ID: I20090325000785

Medical Identifiers

Medical identifiers for Jeff William Shively such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1376782961	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1041C0700X	Social Worker - Clinical	18053 (Minnesota)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jeff William Shively allows following entities to bill medicare on his behalf.

Entity Name	Soul Work Counseling, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1710295001 PECOS PAC ID: 4789910233 Enrollment ID: O20190723000039

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jeff William Shively is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Jeff William Shively, LICSW 12805 Highway 55, Suite 200, Plymouth, MN 55441-3859 Ph: (612) 723-0408	Jeff William Shively, LICSW 12805 Highway 55, Suite 200, Plymouth, MN 55441-3859 Ph: (612) 723-0408

Reviews and Comments

Social Worker in Plymouth, MN

Katelyn Sarah Kubista, MSW, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 10000 Hwy 55 Ste 200, Plymouth, MN 55441 Phone: 586-707-7085
Danielle Norgren, Clinical Social Worker Medicare: May Accept Medicare Assignments Practice Location: 3251 Fernbrook Ln N, Plymouth, MN 55447 Phone: 612-268-5858
Yolonda Yvette Rogers, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 2415 Upland Ln N Unit A, Plymouth, MN 55447 Phone: 612-385-0991
Ying P Elliott, LICSW Clinical Social Worker Medicare: May Accept Medicare Assignments Practice Location: 10700 Old County Road 15 Ste 170, Plymouth, MN 55441 Phone: 763-525-8590 Fax: 763-525-8592
Jamie Schley, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 9800 Rockford Rd, Suite 100, Plymouth, MN 55442 Phone: 952-460-9045
Julian Walter Sachs, LICSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 10000 Hwy 55 Ste 200, Plymouth, MN 55441 Phone: 651-243-0149
Laura Michelle Groeneweg, MSW, LICSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 3033 Campus Dr Ste E180, Plymouth, MN 55441 Phone: 524-609-0869 Fax: 763-416-0916

Jeff William Shively, LICSW - Medicare Clinical Social Worker in Plymouth, MN