Individual provider Active NPI

Amy Sandell

  • Clinical Social Worker
  • Mountain Home, AR
National Provider Identifier
1053596403
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
9069-C Issued in AR
Practice address
353 E 8TH St
Mountain Home, AR 72653-4423
Phone
(870) 701-5141
NPI assigned
Jan 4, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 9069-M AR
Case Manager/Care Coordinator 171M00000X
Clinical Social Worker 1041C0700X 9069-C AR Primary

Addresses

Primary practice location

353 E 8TH St
Mountain Home, AR 72653-4423

Mailing address

PO Box 299
Hoxie, AR 72433-0299
Phone (870) 701-5141

Other practice location 1

18 County Road 458
Mountain Home, AR 72653-8212
Phone (870) 425-5252

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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

Enrollment IDStateProvider typePAC IDDetails
I20210331000702 AR Practitioner - Clinical Social Worker 1254748601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hometown Behavioral Health Services of Arkansas, IncGroup PAC ID 4183779226, 13 clinicians

Practice addresses (Care Compare)

353 E 8TH St
Mountain Home, AR 72653-4423
Phone (870) 701-5141

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9069-MARMDSocial Worker
9069-CARMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Hometown Behavioral Health Services of Ak Inc. Clinical CurrentSince Mar 2, 2021 Accepting new patients
Hometown Behavioral Health Services of Arkansas, Inc CurrentSince Mar 2, 2021 Accepting new patients
Ascent Acquisitions Corp-Cypdc Past Accepting new patients

Locations

503 SE Lindsey St
Hoxie, AR 72433
Phone (870) 886-1333

353 E 8th St
Mountain Home, AR 72653
Phone (870) 425-3125

Organizations & group practices 3

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": "1199404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1053596403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 299",
            "city": "HOXIE",
            "state": "AR",
            "postal_code": "724330299",
            "telephone_number": "870-701-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 E 8TH ST",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726534423",
            "telephone_number": "870-701-5141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18 County Road 458",
            "address_purpose": "LOCATION",
            "city": "Mountain Home",
            "state": "AR",
            "postal_code": "726538212",
            "country_code": "US",
            "telephone_number": "870-425-5252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDELL",
        "first_name": "AMY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-04",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AR",
            "license": "9069-M",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "9069-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home, AR

Sources for this page

Verify at the official NPI Registry.