JEAN ELYSE DIEVENDORF – Social Worker, NPI 1184173981
Social Worker
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,376 CLINICAL SOCIAL WORKER in FL
Provider Addresses for JEAN ELYSE DIEVENDORF
4630 Lipscomb St NE Ste 1A
Palm Bay, FL 329052940
Phone: (321) 405-2583
Type: Location
1127 S Patrick Dr
Satellite Beach, FL 329373939
Phone: (321) 773-1111
Fax: (321) 773-1692
Type: Location
2475 Palm Bay Rd NE
Suite 130 #4
Palm Bay, FL 32905
Phone: (321) 405-2583
Type: Location
2475, Palm Bay Road Northeast, Palm Bay, Brevard County, Florida, 32905, United States
SUITE 130 #4
PALM BAY, FL 32905
Phone: (321) 405-2583
Type: Location
4630 LIPSCOMB ST NE STE 1A
PALM BAY, FL 329052940
Phone: (321) 405-2583
Type: Location
6050 BABCOCK ST SE STE 32
PALM BAY, FL 329094205
Phone: (321) 684-8265
Type: Location
2257, Whiteside Avenue Southeast, Palm Bay, Brevard County, Florida, 32909, United States
PALM BAY, FL 329096044
Phone: (321) 405-2583
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-04-21
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20200421000920 | I | Clinical Social Worker | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32905)
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