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JAIME GUNDERSON LCSW, CSAC
NPI 1164955878
Social Worker in Mayville, WI

Active since April 10, 2017PECOS Enrolled
1446 HORICON ST, MAYVILLE, WI 53050(920) 539-0219 Get Directions Write a Review

NPPES record last updated: October 23, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 23, 2022, Aug 2, 2021, Apr 10, 2017 (3 updates tracked since 2017).

About Jaime Gunderson Lcsw, Csac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JAIME GUNDERSON LCSW, CSAC (NPI 1164955878) is an individual social worker in Mayville, Wisconsin, licensed in Wisconsin (131568-121) and active in the NPI registry since April 2017. She is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1164955878
Entity TypeIndividualFemale
Primary Taxonomy104100000X
Provider Legal NameJAIME GUNDERSONCredential: LCSW, CSAC
Location Address1446 HORICON STMayville, WI 53050-1467
Mailing Address710 N Milwaukee StTheresa, WI 53091-9716 · (920) 539-0219
Phone(920) 539-0219
Sole ProprietorYes
Medical School CMSOtherGraduated 2019
Enumeration DateApril 10, 2017
Last NPPES UpdateOctober 23, 20223 updates tracked since enumeration
NPPES CertifiedOctober 23, 2022
✔ NPI 1164955878 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers
Taxonomy Code104100000X
License✔ Licensed in WI · 131568-121
Definition
A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 16566-132 (WI)
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X · License 9826-123 (WI)
1446 HORICON ST, Mayville, WI 53050
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Other Identifiers 1

Medicaid1164955878WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), Dean Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jaime Gunderson Lcsw, Csac is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5092109652
PECOS Enrollment IDI20220224000317
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jaime Gunderson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Kettle Moraine Counseling LLC
20 mi
Mental Health (Including Community Mental Health Center)
400 W RIVER DR
West Bend, WI 53090
  • Reassigned Medicare billing, Wisconsin enrollment
  • 32 clinicians in this Medicare group
NPI 1568790954 (262) 334-4340

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHAEL ALEXANDER BAUMHARDT
Counselor
1446 HORICON ST
MAYVILLE, WI 53050
Dodge County (262) 334-4340
KAYLA JO NONHOF APSW, SAC-IT
Social Worker
1446 HORICON ST
MAYVILLE, WI 53050
Dodge County (262) 334-4340

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jaime Gunderson's NPI number?

The NPI number for Jaime Gunderson is 1164955878. It was assigned to this individual provider in the NPPES registry on April 10, 2017.

Where is Jaime Gunderson located?

Jaime Gunderson practices at 1446 Horicon St, Mayville, WI 53050. The listed phone number is (920) 539-0219.

What is Jaime Gunderson's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Is Jaime Gunderson enrolled in Medicare?

Yes. Jaime Gunderson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jaime Gunderson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jaime Gunderson reassigns Medicare benefits to Kettle Moraine Counseling LLC (West Bend, WI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jaime Gunderson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jaime Gunderson accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), Dean Health Plan, Group Health Cooperative-SCW and HealthPartners and 4 other insurers list Jaime Gunderson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jaime Gunderson was last updated on October 23, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.