Individual provider Active NPI

Marcus Andrew Mather, LCSW

  • Clinical Social Worker
  • Phoenix, AZ
National Provider Identifier
1073275749
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-19543 Issued in AZ
Practice address
635 E Baseline Rd
Phoenix, AZ 85042-6583
Phone
(022) 437-2776
NPI assigned
Oct 11, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

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 LCSW-19543 AZ Primary

Addresses

Primary practice location

635 E Baseline Rd
Phoenix, AZ 85042-6583

Mailing address

1320 E Highland Ave Apt 39
Phoenix, AZ 85014-3735
Phone (602) 290-9207

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20211208003337 AZ Practitioner - Clinical Social Worker 2264822170 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Park Health Center CurrentSince Dec 6, 2021 Accepting new patients
Mountain Park Health Center CurrentSince Dec 6, 2021 Accepting new patients
Mountain Park Health Center Current Accepting new patients

Locations

635 E Baseline Rd
Phoenix, AZ 85042

3003 N Central Ave
Ste 1600
Phoenix, AZ 85012
Phone (602) 323-3492

Organizations & group practices 3

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": "1633910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1073275749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 E HIGHLAND AVE APT 39",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850143735",
            "telephone_number": "602-290-9207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 E BASELINE RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850426583",
            "telephone_number": "022-437-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHER",
        "first_name": "MARCUS",
        "middle_name": "ANDREW",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-11",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-19543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.