Jennifer L Roll, LISW-S, LICDC is a medicare enrolled "Social Worker - Clinical" provider in Moraine, Ohio. Her current practice location is
3095 Kettering Blvd, Moraine, Ohio. You can reach out to her office (for appointments etc.) via phone at
(937) 293-8300.
Jennifer L Roll is licensed to practice in Ohio (license number I.1901910) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1912376708.
Healthcare Provider's Profile
| Full Name | Jennifer L Roll |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 3095 Kettering Blvd, Moraine, Ohio |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1912376708
- Provider Enumeration Date: 09/22/2015
- Last Update Date: 12/21/2021
Medicare PECOS Information:
- PECOS PAC ID: 5799104980
- Enrollment ID: I20201008000708
Medical Identifiers
Medical identifiers for Jennifer L Roll such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1912376708 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LICDC.162108 (Ohio) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LCDCIII.161339 (Ohio) | Secondary |
| 1041C0700X | Social Worker - Clinical | I.1901910 (Ohio) | 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. Jennifer L Roll allows following entities to bill medicare on her behalf.
| Entity Name | South Community Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1427289818
PECOS PAC ID: 7315971066
Enrollment ID: O20050921001092 |
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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. Jennifer L Roll 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 |
|---|
Jennifer L Roll, LISW-S, LICDC
3095 Kettering Blvd,
Moraine, OH 45439-1983
Ph: () - | Jennifer L Roll, LISW-S, LICDC
3095 Kettering Blvd,
Moraine, OH 45439-1983
Ph: (937) 293-8300 |
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