Ingrid L Shadow, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

35298 Issued in TX

Practice address

3540 Manderly PL
Fort Worth, TX 76109-4520

Phone

(817) 739-8170

NPI assigned

Mar 22, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Clinical Social Worker

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Total Life IncGroup PAC ID 8123433034, 113 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Total Life Inc.

  • Group Psychotherapy Psychologist
  • Jupiter, FL
  • NPI 1053909267

  TX

  Medicare reassignment Care Compare group NPD
• Total Life FL PA

  • Integrative Medicine Physician
  • Potomac, MD
  • NPI 1447057286

  TX

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1063272292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 MANDERLY PL",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094520",
            "telephone_number": "817-739-8170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 MANDERLY PL",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094520",
            "telephone_number": "817-739-8170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1607 N Main St Ste A",
            "address_purpose": "LOCATION",
            "city": "Cleburne",
            "state": "TX",
            "postal_code": "760333875",
            "country_code": "US",
            "telephone_number": "817-739-8170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHADOW",
        "first_name": "INGRID",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "35298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nabeel M Shabout, M.D.
• Janet Shackelford, MD
• Jael Shackleford, LPC ASSOCIATE
• Edward Charles Shadiack III, D.O.
• Burton Alexander Shadow
• Caitlin Joy Shaffer, RN
• Howard L Shaffer, MD
• Sarah Elizabeth Shaffer, PA
• Mariam Aisha Shafi, LMSW
• Dana Zipora Shafir, PH.D.

• Clinical Social Worker in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.

Verify at the official NPI Registry.