Individual provider Active NPI

Elizabeth Anne Duncklee, LCSW

  • Clinical Social Worker
  • Tulsa, OK
National Provider Identifier
1023102928
Registry record updated Jun 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
3194 Issued in OK
Practice address
550 S Peoria Ave
Tulsa, OK 74120-3820
Phone
(918) 382-1229
Fax
(918) 582-6405
NPI assigned
Oct 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2015

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 3194 OK Primary

Addresses

Primary practice location

550 S Peoria Ave
Tulsa, OK 74120-3820

Mailing address

550 S Peoria Ave
Tulsa, OK 74120-3820
Phone (918) 382-1229

Other identifiers 6

IdentifierTypeStateIssuer
73-1042545OtherOKGROUP COMMUNITY CARE OF OKLAHOMA
731042545001OtherOKGROUP TRICARE
73-1042545OtherOKGROUP MEDICARE
100732910-AOtherOKGROUP MEDICAID/SOONERCARE
73-1042545OtherOKGROUP BCBS
100732910-GOtherOKGROUP MEDICAID/SOONERCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090115000585 OK Practitioner - Clinical Social Worker 1052474145 Reassigns benefits to 1 organization
I20250926000222 TX Practitioner - Clinical Social Worker 1052474145 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Indian Health Care Resource CenterGroup PAC ID 0042117590, 15 clinicians

Practice addresses (Care Compare)

550 S Peoria Ave
Tulsa, OK 74120-3820
Phone (918) 382-1207

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Indian Health Care Resource Center CurrentSince Oct 20, 2008 Accepting new patients
Indian Health Care Resource Center of Tulsa, Inc. PastSince Oct 20, 2008 Accepting new patients

Locations

550 S Peoria Ave
Tulsa, OK 74120
Phone (918) 382-1207

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434672000000",
    "number": "1023102928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S PEORIA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741203820",
            "telephone_number": "918-382-1229",
            "fax_number": "918-582-6405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S PEORIA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741203820",
            "telephone_number": "918-382-1229",
            "fax_number": "918-582-6405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNCKLEE",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2015-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "3194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP COMMUNITY CARE OF OKLAHOMA",
            "identifier": "73-1042545",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP TRICARE",
            "identifier": "731042545001",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE",
            "identifier": "73-1042545",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID/SOONERCARE",
            "identifier": "100732910-A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BCBS",
            "identifier": "73-1042545",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID/SOONERCARE",
            "identifier": "100732910-G",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.