Individual provider Active NPI

Carleen Annette Mazour, CSW

  • Social Worker
  • Rapid City, SD
National Provider Identifier
1124860119
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6279 Issued in SD
Practice address
3200 Canyon Lake Dr
Rapid City, SD 57702-8114
Phone
(605) 355-2500
NPI assigned
Jun 10, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6279 SD Primary

Addresses

Primary practice location

3200 Canyon Lake Dr
Rapid City, SD 57702-8114

Mailing address

3200 Canyon Lake Dr
Rapid City, SD 57702-8114
Phone (605) 355-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20250915003760 TX Practitioner - Clinical Social Worker 8022512912 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3200 Canyon Lake Dr
Rapid City, SD 57702-8114

3200 Canyon Lake Dr
Rapid City, SD 57702-8197

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6279SDMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Great Plains Tribal Chairmen'S Health Board CurrentSince Aug 25, 2025 Accepting new patients

Locations

3200 Canyon Lake Dr
Rapid City, SD 57702
Phone (605) 355-2282

3200 Canyon Lake Dr
Ste 1
Rapid City, SD 57702
Phone (605) 355-2500

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": "1717977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1124860119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 CANYON LAKE DR",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577028114",
            "telephone_number": "605-355-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CANYON LAKE DR",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577028114",
            "telephone_number": "605-355-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZOUR",
        "first_name": "CARLEEN",
        "middle_name": "ANNETTE",
        "credential": "CSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "SD",
            "license": "6279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.