Renae L Vitale, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4704 Issued in OK

Practice address

205 S Park LN
Altus, OK 73521-5755

Phone

(580) 379-6850

Fax

(580) 379-6859

NPI assigned

Mar 4, 2014

Last updated

Dec 4, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OK

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

Specialty

Clinical Social Worker

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jackson County Memorial Hospital AuthorityGroup PAC ID 1759293178, 46 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  Medicare reassignment Care Compare group NPD
• Jackson County Memorial Hospital Authority

  dba Harmon Memorial Hospital

  • Critical Access Hospital
  • Hollis, OK
  • NPI 1295735991
  NPD
• Jackson County Memorial Hosp Phcy

  dba Jackson County Memorial Hospital Pharmacy

  • Institutional Pharmacy
  • Altus, OK
  • NPI 1518028380
  NPD (past)

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

{
    "created_epoch": "1393891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1013332733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8190",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735228190",
            "telephone_number": "580-379-6850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 S PARK LN",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735215755",
            "telephone_number": "580-379-6850",
            "fax_number": "580-379-6859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITALE",
        "first_name": "RENAE",
        "middle_name": "L",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-04",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "4704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200531990A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "RenaeVitale@direct.jcmh.com",
            "affiliation": "N",
            "address_1": "205 S Park Ln",
            "city": "Altus",
            "state": "OK",
            "country_code": "US",
            "postal_code": "735215755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Steven C Vaughan, DPH
• Brandy Jo Vermillion, APRN-CNP
• Juan Ruben Villazon, M.D.
• Vision Source Altus PLLC
• Neil B Vitale, M.D.
• Rebecca Merre Waechter, MA
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0479)
• Walgreen Co (Walgreens #09670)
• John Wall
• Rick M Wallace, FSP

• Clinical Social Worker in Altus, OK
• Providers in Altus, OK by specialty
• Clinical Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.