MR. JEFFRY DAVID JEANETTA WARK MA LICSW
NPI 1982778932
Social Worker - Clinical in Roseville, MN
About Mr. Jeffry David Jeanetta Wark Ma Licsw NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. JEFFRY DAVID JEANETTA WARK MA LICSW (NPI 1982778932) is an individual clinical provider in Roseville, Minnesota, licensed in Minnesota (09459) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1991).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mr. Jeffry David Jeanetta Wark Ma Licsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Jeffry Jeanetta Wark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Saint Paul, MN 55105
- Reassigned Medicare billing, Minnesota enrollment
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 55113 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 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
ROSEVILLE, MN 55113
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 Jeffry Jeanetta Wark's NPI number?
The NPI number for Jeffry Jeanetta Wark is 1982778932. It was assigned to this individual provider in the NPPES registry on November 20, 2006.
Where is Jeffry Jeanetta Wark located?
Jeffry Jeanetta Wark practices at 1751 County Road B W Ste 100, Roseville, MN 55113. The listed phone number is (651) 698-0768.
What is Jeffry Jeanetta Wark's specialty?
The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.
Is Jeffry Jeanetta Wark enrolled in Medicare?
Yes. Jeffry Jeanetta Wark is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Jeffry Jeanetta Wark's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jeffry Jeanetta Wark reassigns Medicare benefits to Center For Integrated Well Being Inc (Saint Paul, 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 Jeffry Jeanetta Wark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jeffry Jeanetta Wark was last updated on March 21, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.
# Mr. Jeffry David Jeanetta Wark, MA LICSW · NPI 1982778932
Clinical provider in Roseville, Minnesota. Individual provider, active in the CMS NPPES registry since November 20, 2006.
## Identity
- **NPI:** 1982778932 (Entity type: Individual)
- **Enumerated:** November 20, 2006
- **Primary specialty:** Social Worker - Clinical · taxonomy 1041C0700X
- **State license:** 09459 (Minnesota)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1751 COUNTY ROAD B W STE 100, Roseville, MN 55113-4037
- **Phone:** (651) 698-0768
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Center For Integrated Well Being Inc (NPI 1053485003, Saint Paul, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1991
## Record status
- **NPPES last updated:** March 21, 2018
- **Other identifiers:** Other 13GS2WA; Other 483889
---
Source: [NPI Profile](https://npiprofile.com/npi/1982778932) · Data from the CMS NPPES public registry.