Individual provider Active NPI

Rebecca McKelley, LISW

  • Clinical Social Worker
  • Wooster, OH
National Provider Identifier
1063614287
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I-7679 Issued in OH
Practice address
2685 Armstrong Rd
Wooster, OH 44691-9041
Phone
(330) 345-7949
Fax
(330) 345-5218
NPI assigned
Jun 1, 2007
Sex
Female
Sole proprietor
No

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 I-7679 OH Primary

Addresses

Primary practice location

2685 Armstrong Rd
Wooster, OH 44691-9041

Mailing address

PO Box 765
Wooster, OH 44691-0765
Phone (330) 345-7949

Other identifiers 1

IdentifierTypeStateIssuer
10042MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
I-7679OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Christian Children'S Home of Ohio PastSince Jun 22, 2021 Accepting new patients
Christian Children'S Home of Ohio PastSince Sep 1, 2017 Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/cchoo/r4/

Organizations & group practices 2

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": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063614287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 765",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446910765",
            "telephone_number": "330-345-7949",
            "fax_number": "330-345-5218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2685 ARMSTRONG RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446919041",
            "telephone_number": "330-345-7949",
            "fax_number": "330-345-5218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKELLEY",
        "first_name": "REBECCA",
        "name_prefix": "Mrs.",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I-7679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10042",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wooster, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.