JEFF WILLIAM SHIVELY LICSW
NPI 1376782961
Social Worker - Clinical in Plymouth, MN
About Jeff William Shively Licsw NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JEFF WILLIAM SHIVELY LICSW (NPI 1376782961) is an individual clinical provider in Plymouth, Minnesota, licensed in Minnesota (18053) and active in the NPI registry since February 2009. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jeff William Shively Licsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Jeff Shively reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Blaine, MN 55434
- Reassigned Medicare billing, Minnesota enrollment
- 18 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55441 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 18
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
PLYMOUTH, MN 55441
PLYMOUTH, MN 55441
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 Jeff Shively's NPI number?
The NPI number for Jeff Shively is 1376782961. It was assigned to this individual provider in the NPPES registry on February 5, 2009.
Where is Jeff Shively located?
Jeff Shively practices at 12805 Highway 55 Suite 200, Plymouth, MN 55441. The listed phone number is (612) 723-0408.
What is Jeff Shively's specialty?
The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.
Is Jeff Shively enrolled in Medicare?
Yes. Jeff Shively is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Jeff Shively's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jeff Shively reassigns Medicare benefits to Soul Work Counseling, LLC (Blaine, MN). 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 Jeff Shively's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jeff Shively accept?
Health plans from HealthPartners list Jeff Shively 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 Jeff Shively was last updated on March 5, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.
# Jeff William Shively, LICSW · NPI 1376782961
Clinical provider in Plymouth, Minnesota. Individual provider, active in the CMS NPPES registry since February 5, 2009.
## Identity
- **NPI:** 1376782961 (Entity type: Individual)
- **Enumerated:** February 5, 2009
- **Primary specialty:** Social Worker - Clinical · taxonomy 1041C0700X
- **State license:** 18053 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 12805 HIGHWAY 55, SUITE 200, Plymouth, MN 55441-3859
- **Phone:** (612) 723-0408 · **Fax:** (763) 210-5379
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Soul Work Counseling, LLC (NPI 1710295001, Blaine, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 5, 2013
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Source: [NPI Profile](https://npiprofile.com/npi/1376782961) · Data from the CMS NPPES public registry.