Active NPI
Susan Ann Waterman, LCSW
- Clinical Social Worker
- Medford, OR
National Provider Identifier
1023148376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1273
- Practice address
- 107 E Main St
Suite 7
Medford, OR 97501-6048 - Phone
- (541) 772-2791
- Fax
- (541) 772-2791
- NPI assigned
- Mar 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1273 | OR | Primary |
Addresses
Primary practice location
107 E Main St
Suite 7
Medford, OR 97501-6048
Mailing address
107 E Main St
Suite 7
Medford, OR 97501-6048
Phone (541) 772-2791
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jun 30, 2015 through Jun 30, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1273 | OR | MD | Naturopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023148376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 E MAIN ST",
"address_2": "SUITE 7",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975016048",
"telephone_number": "541-772-2791",
"fax_number": "541-772-2791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 E MAIN ST",
"address_2": "SUITE 7",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975016048",
"telephone_number": "541-772-2791",
"fax_number": "541-772-2791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERMAN",
"first_name": "SUSAN",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "1273",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.