Individual provider Active NPI

Crystal Chance, LCSW

  • Clinical Social Worker
  • Fredericksburg, VA
National Provider Identifier
1104293711
Registry record updated Sep 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904009134 Issued in VA
Practice address
1965 Jefferson Davis Hwy
Fredericksburg, VA 22401
Phone
(540) 735-0650
Fax
(540) 735-0567
NPI assigned
Aug 31, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2018

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 0904009134 VA Primary

Addresses

Primary practice location

1965 Jefferson Davis Hwy
Fredericksburg, VA 22401

Mailing address

1965 Jefferson Davis Hwy
Fredericksburg, VA 22401-6213
Phone (540) 735-0650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20170201002614 VA Practitioner - Clinical Social Worker 5395028138 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Virginia Health Services IncGroup PAC ID 0345158432, 94 clinicians

Practice addresses (Care Compare)

102 W Broaddus Ave
Suite 200
Bowling Green, VA 22427-9404
Phone (804) 632-1030

165 Legrande Ave
Charlotte Court House, VA 23923-3747
Phone (434) 542-5560

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Central Virginia Health Services Inc CurrentSince Sep 19, 2018 Accepting new patients
Central Virginia Health Services Inc Current Accepting new patients
Central Virginia Health Services Inc CurrentSince Sep 19, 2018 Accepting new patients
Central Virginia Health Services Inc Past Accepting new patients

Locations

1965 Emancipation Hwy
Ste 100
Fredericksburg, VA 22401
Phone (540) 735-0560

25892 N James Madison Hwy
New Canton, VA 23123
Phone (434) 581-3271

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1440979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536192000000",
    "number": "1104293711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1965 JEFFERSON DAVIS HWY",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224016213",
            "telephone_number": "540-735-0650",
            "fax_number": "540-735-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1965 JEFFERSON DAVIS HWY",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "22401",
            "telephone_number": "540-735-0650",
            "fax_number": "540-735-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANCE",
        "first_name": "CRYSTAL",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-31",
        "last_updated": "2018-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904009134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

Verify at the official NPI Registry.