Individual provider Active NPI

Ann G McDonald, LISW

  • Clinical Social Worker
  • Davenport, IA
National Provider Identifier
1104814839
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
00988 Issued in IA
Practice address
4455 E 56TH St
Davenport, IA 52807-2995
Phone
(563) 355-2577
Fax
(563) 355-4015
NPI assigned
Oct 6, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 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 00988 IA Primary

Addresses

Primary practice location

4455 E 56TH St
Davenport, IA 52807-2995

Mailing address

865 Lincoln Rd
Ste L10
Bettendorf, IA 52722-4190
Phone (563) 355-9191

Other identifiers 3

IdentifierTypeStateIssuer
1414722MedicaidIA
37650OtherIAWELLMARK HEALTH PLAN
IA01M3OtherJOHN DEERE HEALTH PLAN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ann.mcdonald@direct.genesishealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20050104000761 IA Practitioner - Clinical Social Worker 2961460720 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Genesis Health SystemGroup PAC ID 7214841436, 217 clinicians

Practice addresses (Care Compare)

4455 E 56TH St
Mercyone Genesis Psychology Associa
Davenport, IA 52807-2995
Phone (563) 355-2577

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00988IAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Health System CurrentSince Jul 1, 2006 Accepting new patients
Genesis Health System CurrentSince Jul 1, 2006 Accepting new patients
Genesis Health System Current Accepting new patients
Lutheran Family Service PastSince Jun 1, 2016 Accepting new patients

Locations

865 Lincoln Rd
Ste L10
Bettendorf, IA 52722
Phone (563) 355-9191

1351 W Central Park Ave
Ste 340
Davenport, IA 52804
Phone (563) 421-1287

4455 E 56th St
Davenport, IA 52807
Phone (563) 355-2577

619 5th St
Durant, IA 52747
Phone (563) 785-4487

Interoperability endpoints

  • Direct secure messaging: ann.mcdonald@direct.genesishealth.com

Organizations & group practices 5

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": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1104814839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 LINCOLN RD",
            "address_2": "STE L10",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527224190",
            "telephone_number": "563-355-9191",
            "fax_number": "563-355-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 E 56TH ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072995",
            "telephone_number": "563-355-2577",
            "fax_number": "563-355-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "ANN",
        "middle_name": "G",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-06",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "00988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1414722",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK HEALTH PLAN",
            "identifier": "37650",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH PLAN",
            "identifier": "IA01M3",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ann.mcdonald@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis health system direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "4455 E 56th St",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528072995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.