Individual provider Active NPI

George Wallace Hearne, LCSW

  • Clinical Social Worker
  • Sacramento, CA
National Provider Identifier
1063533842
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS 13333 Issued in CA
Practice address
3517 Marconi Ave
Suite 205
Sacramento, CA 95821-5328
Phone
(916) 482-3070
Fax
(916) 482-3070
NPI assigned
Apr 2, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCS 13333 CA Primary

Addresses

Primary practice location

3517 Marconi Ave
Suite 205
Sacramento, CA 95821-5328

Mailing address

3517 Marconi Ave
Suite 205
Sacramento, CA 95821-5328
Phone (916) 482-3070

Other identifiers 3

IdentifierTypeStateIssuer
112764 UBSOtherCAUNITED BEHAVIORAL HEALTH
7479110OtherCAAETNA BEHAVIORAL HEALTH
049741OtherCAMHN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20120306000108 CA Practitioner - Clinical Social Worker 5395904767 Practice locations: Sacramento, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3517 Marconi Ave
Suite 205
Sacramento, CA 95821-5341
Phone (916) 482-3070

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS 13333CAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063533842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3517 MARCONI AVE",
            "address_2": "SUITE 205",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958215328",
            "telephone_number": "916-482-3070",
            "fax_number": "916-482-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3517 MARCONI AVE",
            "address_2": "SUITE 205",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958215328",
            "telephone_number": "916-482-3070",
            "fax_number": "916-482-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEARNE",
        "first_name": "GEORGE",
        "middle_name": "WALLACE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 13333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "112764 UBS",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA BEHAVIORAL HEALTH",
            "identifier": "7479110",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "049741",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.