Individual provider Active NPI

Conrad E. Larkin, L.C.S.W.

  • Clinical Social Worker
  • Santa Rosa, CA
National Provider Identifier
1104983238
Registry record updated Dec 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
5501 Issued in CA
Practice address
924 Langeburg St
Santa Rosa, CA 95407-2533
Phone
(707) 566-7570
NPI assigned
Jan 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2017

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 5501 CA Primary

Addresses

Primary practice location

924 Langeburg St
Santa Rosa, CA 95407-2533

Mailing address

422 Larkfield Ctr
#255
Santa Rosa, CA 95403-1408
Phone (707) 566-7570

Other identifiers 1

IdentifierTypeStateIssuer
CSW055010MedicaidCA

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
I20050808000912 CA Practitioner - Clinical Social Worker 5092750182 Reassigns benefits to 1 organization
Practice locations: Lakeport, CA; Santa Rosa, CA; Ukiah, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1971
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1162 S Dora St
Ukiah, CA 95482-6340
Phone (707) 462-1436

422 Larkfield Ctr
Suite 255
Santa Rosa, CA 95403-1408

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PC Clinical CurrentSince Jul 1, 2024 Accepting new patients

Locations

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

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": "1167609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514246400000",
    "number": "1104983238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 LARKFIELD CTR",
            "address_2": "#255",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031408",
            "telephone_number": "707-566-7570",
            "fax_number": "707-312-5659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 LANGEBURG ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954072533",
            "telephone_number": "707-566-7570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARKIN",
        "first_name": "CONRAD",
        "middle_name": "E.",
        "name_prefix": "Mr.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-01",
        "last_updated": "2017-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "5501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CSW055010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.