Individual provider Active NPI

Claude Ann Poupolos, MSW

  • Social Worker
  • Gary, IN
National Provider Identifier
1063828879
Registry record updated Jul 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
1100 W 6TH Ave
Gary, IN 46402-1711
Phone
(219) 885-4264
Fax
(219) 886-1332
NPI assigned
Jul 1, 2014
Last updated
Jul 1, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Social Worker 104100000X Primary

Addresses

Primary practice location

1100 W 6TH Ave
Gary, IN 46402-1711

Mailing address

6055 Virginia St
Merrillville, IN 46410-3035
Phone (219) 779-0509

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20170517001714 IN Practitioner - Clinical Social Worker 6507133857 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

111 W 86TH Ave
Suite E
Merrillville, IN 46410-7087
Phone (219) 779-0509

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Gemswithin Mental Health CurrentSince Feb 1, 2021 Accepting new patients
Community Healthnet Inc CurrentSince May 5, 2017 Accepting new patients
Community Healthnet Inc CurrentSince May 5, 2017 Accepting new patients
Family Matters Institute, Inc. Past Accepting new patients

Locations

756 N Madison St
Crown Point, IN 46307
Phone (219) 712-1714

1021 W 5th Ave
Gary, IN 46402

111 W 86th Ave
Ste E
Merrillville, IN 46410
Phone (219) 779-0509

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404172800000",
    "number": "1063828879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6055 VIRGINIA ST",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464103035",
            "telephone_number": "219-779-0509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 W 6TH AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464021711",
            "telephone_number": "219-885-4264",
            "fax_number": "219-886-1332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POUPOLOS",
        "first_name": "CLAUDE ANN",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-01",
        "last_updated": "2014-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gary, IN

Sources for this page

Verify at the official NPI Registry.