Active NPI
Carleen Annette Mazour, CSW
- Social Worker
- Rapid City, SD
National Provider Identifier
1124860119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6279
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6279 | SD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Great Plains Tribal Chairmen'S Health Board | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.