Active NPI
Richard Young Modenbach, LCSW
- Clinical Social Worker
- Tulsa, OK
National Provider Identifier
1053643429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1891
- Practice address
- 744 W 9TH St
8TH Floor
Tulsa, OK 74127-9020 - Phone
- (918) 599-5730
- Fax
- (918) 599-5859
- NPI assigned
- Feb 9, 2010
- Sex
- Male
- 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 | 1891 | OK | Primary |
Addresses
Primary practice location
744 W 9TH St
8TH Floor
Tulsa, OK 74127-9020
Mailing address
744 W 9TH St
8TH Floor
Tulsa, OK 74127-9020
Phone (918) 599-5730
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1972
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2502 E 71St St
Tulsa, OK 74136-5531
Phone (918) 587-1200
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Tristesse Grief Center Inc | Clinical | Current | Accepting new patients |
Locations
2502 E 71st St
Tulsa, OK 74136
Phone (918) 587-1200
Organizations & group practices 1
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": "1265673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265673600000",
"number": "1053643429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "744 W 9TH ST",
"address_2": "8TH FLOOR",
"city": "TULSA",
"state": "OK",
"postal_code": "741279020",
"telephone_number": "918-599-5730",
"fax_number": "918-599-5859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "744 W 9TH ST",
"address_2": "8TH FLOOR",
"city": "TULSA",
"state": "OK",
"postal_code": "741279020",
"telephone_number": "918-599-5730",
"fax_number": "918-599-5859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODENBACH",
"first_name": "RICHARD",
"middle_name": "YOUNG",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-09",
"last_updated": "2010-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OK",
"license": "1891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.