Douglas Alan Brink, LISW, LMFT

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

05899 Issued in IA

Practice address

202 1St St SE
Suite 107
Mason City, IA 50401-3946

Phone

(641) 423-3778

Fax

(641) 423-3881

NPI assigned

Jun 16, 2005

Last updated

Aug 12, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Lutheran Services in Iowa, Inc.

  • Social Worker
  • Des Moines, IA
  • NPI 1831278142
  NPD (past)

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376265600000",
    "number": "1023013174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 1ST ST SE",
            "address_2": "SUITE 107",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504013946",
            "telephone_number": "641-423-3778",
            "fax_number": "641-423-3881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 1ST ST SE",
            "address_2": "SUITE 107",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504013946",
            "telephone_number": "641-423-3778",
            "fax_number": "641-423-3881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRINK",
        "first_name": "DOUGLAS",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "LISW,  LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2013-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "05899",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "0378",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0446336",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE CROSS BLUE SHIELD",
            "identifier": "72639",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven J. Brau
• Briana Taylor Brayton, DDS
• Jacob Brekken, PA
• Randall Scott Brenton, M.D.
• Bridget Marie Powers (Grady Counseling Services)
• Erik David Brink, D.O.
• Nicholas Broadbent, D.O.
• Colton Broadhead, PT, DPT
• Deborah Broers, RN
• Sara Brooks

• Clinical Social Worker in Mason City, IA
• Providers in Mason City, IA by specialty
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.