Kim Prodger, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 12046 Issued in CA

Practice address

4010 Watson Plaza Dr
Suite 285
Lakewood, CA 90712-4037

Phone

(562) 497-1505

Fax

(562) 497-1881

NPI assigned

Feb 5, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Mark David Levine M.D. Professional Corporation

  dba Mindpath Health

  • Psychiatry Physician
  • Sacramento, CA
  • NPI 1154697944

  Clinical

  NPD
• Mark David Levine, MD Burlingame PC

  dba Community Psychiatry Associates

  • Psychiatry Physician
  • San Mateo, CA
  • NPI 1770709263
  NPD

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114066404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 WATSON PLAZA DR",
            "address_2": "SUITE 285",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907124037",
            "telephone_number": "562-497-1505",
            "fax_number": "562-497-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 WATSON PLAZA DR",
            "address_2": "SUITE 285",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907124037",
            "telephone_number": "562-497-1505",
            "fax_number": "562-497-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRODGER",
        "first_name": "KIM",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 12046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Aco Physicians Network, Inc
• Premier Health Plan Services, Inc.
• Prep Ed Programs Inc. (P.E.P. Inc.)
• Primary Care Associates of California
• Rose Primus
• Prohealth Partners a Medical Group
• Prohealth Partners a Medical Group
• Prohealth Partners a Medical Group Inc
• Prohealth Partners a Medical Group Inc
• Prohealth Partners a Medical Group Inc

• Clinical Social Worker in Lakewood, CA
• Providers in Lakewood, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.