JACQUELINE BLACK LMHC
NPI 1457912420
Social Worker - Clinical in Indianapolis, IN

Q: What is Jacqueline Black's NPI number?

The NPI number for Jacqueline Black is 1457912420. It was assigned to this individual provider in the NPPES registry on June 21, 2019.

Q: What is Jacqueline Black's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Jacqueline Black was last updated on May 6, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 21, 2019PECOS EnrolledAccepts Medicare Assignment

1030 E COUNTY LINE RD STE C1, INDIANAPOLIS, IN 46227(317) 497-6290 Get Directions Write a Review

NPPES record last updated: May 6, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 6, 2025, Jun 21, 2019 (2 updates tracked since 2019).

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About Jacqueline Black Lmhc NPPES

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

JACQUELINE BLACK LMHC (NPI 1457912420) is an individual clinical provider in Indianapolis, Indiana, licensed in Indiana (39003454A) and active in the NPI registry since June 2019. She is enrolled in Medicare PECOS, is affiliated with Community Hospital East, and maintains a secondary practice location in Indianapolis.

NPPES Registry Identity

NPI1457912420

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameJACQUELINE BLACKCredential: LMHC

Location Address1030 E COUNTY LINE RD STE C1Indianapolis, IN 46227-2998

Mailing Address6626 E 75th St Ste 500Indianapolis, IN 46250-2890

Phone(317) 497-6290

Sole ProprietorNo

Medical School CMSOtherGraduated 2014

Enumeration DateJune 21, 2019

Last NPPES UpdateMay 6, 20252 updates tracked since enumeration

NPPES CertifiedMay 6, 2025

✔ NPI 1457912420 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in IN · 39003454A

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

1030 E COUNTY LINE RD STE C1, Indianapolis, IN 46227

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Secondary Practice Location 1

Location 16950 Hillsdale CtIndianapolis, IN 46250-2040 · Phone (317) 621-7740

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacqueline Black Lmhc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8426577321

PECOS Enrollment IDI20250523000668

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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Community Hospital East

Acute Care Hospitals · Indianapolis, IN

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number150074

Location1500 N Ritter AveIndianapolis, IN 46219 · Marion County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46227 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $53.07 – $161.76

Typical copayment $0.00 (range $13.26 – $40.44)

Most-billed visit code NA

Established Patient

$66.48 typical visit price

range $16.93 – $132.22

Typical copayment $16.62 (range $4.23 – $33.05)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 9

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

MICHAEL CHARNSTROM

Social Worker (Clinical)