Active NPI
Shavalia Ingram
- Clinical Social Worker
- Chapel Hill, NC
National Provider Identifier
1043745672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- PO10824
- Practice address
- 1828 Martin Luther King Jr Blvd
Chapel Hill, NC 27514-7415 - Phone
- (919) 951-7600
- NPI assigned
- Apr 20, 2017
- 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 | PO10824 | NC | Primary |
Addresses
Primary practice location
1828 Martin Luther King Jr Blvd
Chapel Hill, NC 27514-7415
Mailing address
1828 Martin Luther King Jr Blvd
Chapel Hill, NC 27514-7415
Phone (919) 951-7600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6003238 | Medicaid | NC |
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PO10824 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492646400000",
"number": "1043745672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1828 MARTIN LUTHER KING JR BLVD",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275147415",
"telephone_number": "919-951-7600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1828 MARTIN LUTHER KING JR BLVD",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275147415",
"telephone_number": "919-951-7600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGRAM",
"first_name": "SHAVALIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-20",
"last_updated": "2017-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "PO10824",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6003238",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chapel Hill, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.