Edna Chism Nicholas

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

55023 Issued in TX

Practice address

3309 Winthrop Ave
90
Fort Worth, TX 76116-5614

Phone

(214) 886-4872

NPI assigned

Apr 22, 2014

Last updated

Nov 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Clinical Social Worker

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Authentic Counseling and Coaching Center, LLC

  • Clinical Social Worker
  • Fort Worth, TX
  • NPI 1891105292

  Addiction (Substance Use Disorder)

  Medicare reassignment NPD

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

{
    "created_epoch": "1398124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1073933669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8628 PAPER BIRCH LN",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761235058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3309 WINTHROP AVE",
            "address_2": "90",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761165614",
            "telephone_number": "214-886-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISM NICHOLAS",
        "first_name": "EDNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-22",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "12258",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "55023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chisholm Trail Oral Surgery PLLC
• Chisholm Trail Orthopedics & Sports Medicine, LLLP
• Chisholm Trail Scal LLC (Chisholm Trail Senior Living)
• Allison Gail Chisholm, M.D
• Edward Lee Chisholm, MS, LAT, ATC
• Anthony L Chism
• Chilando Melody Chitobolo, LPC-A
• Srivalli Chittajallu, PA-C
• Chris Chiu
• Ilene Chiu, M.D.

• Clinical Social Worker in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.