Individual provider Active NPI

Mark David McOmber, LCSW

  • Clinical Social Worker
  • Clovis, CA
National Provider Identifier
1104941830
Registry record updated Dec 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS 26149 Issued in CA
Practice address
624 Woodworth Ave
Clovis, CA 93612-1847
Phone
(559) 297-6060
NPI assigned
Mar 20, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 8, 2009

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 LCS 26149 CA Primary

Addresses

Primary practice location

624 Woodworth Ave
Clovis, CA 93612-1847

Mailing address

624 Woodworth Ave
Clovis, CA 93612-1847
Phone (559) 297-6060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20100216000185 CA Practitioner - Clinical Social Worker 9335283381 Practice locations: Clovis, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

624 Woodworth Ave
Clovis, CA 93612-1847
Phone (559) 297-6060

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS 26149CAMDClinical Social Worker
26149CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
North Star Counseling a Licensed Clinical Social Worker Corporation Clinical Past Accepting new patients

Organizations & group practices 1

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": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260230400000",
    "number": "1104941830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 WOODWORTH AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936121847",
            "telephone_number": "559-297-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 WOODWORTH AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936121847",
            "telephone_number": "559-297-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCOMBER",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2009-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 26149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

Verify at the official NPI Registry.