Individual provider Active NPI

Brian James Robertson, LCSW

  • Clinical Social Worker
  • Charlotte, NC
National Provider Identifier
1003570920
Registry record updated Oct 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
4412 Park Rd
Charlotte, NC 28209-3130
Phone
(855) 284-7483
NPI assigned
Oct 27, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

4412 Park Rd
Charlotte, NC 28209-3130

Mailing address

1000 Jefferson St Ste 2C
Lynchburg, VA 24504-1724

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211110001565 NC Practitioner - Clinical Social Worker 2567851728 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thriveworks Clinical - North Carolina PCGroup PAC ID 8527471200, 109 clinicians

Practice addresses (Care Compare)

4412 Park Rd
Charlotte, NC 28209-3130
Phone (980) 581-3061

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Healing Institute, PLLC Clinical Current Accepting new patients
Thriveworks Clinical - North Carolina PC CurrentSince Nov 3, 2021 Accepting new patients

Locations

119 SW Maynard Rd
Cary, NC 27511
Phone (919) 415-1112

3719 Latrobe Dr
Ste 850
Charlotte, NC 28211
Phone (704) 579-6176

4412 Park Rd
Charlotte, NC 28209
Phone (855) 675-4144

1000 Jefferson St
Ste 2C
Lynchburg, VA 24504
Phone (434) 528-3263

Networks

  • devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1
  • devoted network organization-0f7f8d4f-1035-4992-8c02-dc86d12e700e
  • devoted network organization-84bf27aa-506a-49c4-8818-702cf5e8efb3
  • TN PPO
  • TN PPO C-SNP

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1003570920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JEFFERSON ST STE 2C",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245041724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4412 PARK RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093130",
            "telephone_number": "855-284-7483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "BRIAN",
        "middle_name": "JAMES",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-27",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.