Individual provider Active NPI

Susan Nightingale, LCSW

  • Clinical Social Worker
  • Washington, DC
National Provider Identifier
1063504173
Registry record updated Jan 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC50078469 Issued in DC
Practice address
1012 14TH St NW
Suite 1000
Washington, DC 20005-3406
Phone
(202) 654-0873
Fax
(202) 654-0868
NPI assigned
Sep 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904005750 VA
Clinical Social Worker 1041C0700X LC50078469 DC Primary

Addresses

Primary practice location

1012 14TH St NW
Suite 1000
Washington, DC 20005-3406

Mailing address

1012 14TH St NW
Suite 1000
Washington, DC 20005-3406
Phone (202) 654-0873

Other identifiers 2

IdentifierTypeStateIssuer
010062144MedicaidDC
010062144MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20260420001414 DC Practitioner - Clinical Social Worker 1456827260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2930 Starry Night PL
Nanjemoy, MD 20662-3032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LC50078469DCMDClinical Social Worker
0904005750VAMDClinical Social Worker

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": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420675200000",
    "number": "1063504173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 14TH ST NW",
            "address_2": "SUITE 1000",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200053406",
            "telephone_number": "202-654-0873",
            "fax_number": "202-654-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 14TH ST NW",
            "address_2": "SUITE 1000",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200053406",
            "telephone_number": "202-654-0873",
            "fax_number": "202-654-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIGHTINGALE",
        "first_name": "SUSAN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2015-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904005750",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC50078469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010062144",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010062144",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.