Chuck Ivy, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C-10013 Issued in NM

Practice address

1407 Highland Rd
Roswell, NM 88201-2146

Phone

(575) 208-2918

Fax

(575) 208-2918

NPI assigned

May 12, 2010

Sex

Male

Sole proprietor

Yes

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

Enrolled in NM

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

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Azurite Services PCGroup PAC ID 0648552133, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Azurite Services PC

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • Roswell, NM
  • NPI 1932650041
  Medicare reassignment Care Compare group NPD
• Ivy League Counseling LLC

  • Social Worker
  • Roswell, NM
  • NPI 1982286308
  NPD Authorized official

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

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614902400000",
    "number": "1134447386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 HIGHLAND RD",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882012146",
            "telephone_number": "575-208-2918",
            "fax_number": "575-208-2918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 HIGHLAND RD",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882012146",
            "telephone_number": "575-208-2918",
            "fax_number": "575-208-2918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVY",
        "first_name": "CHUCK",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-12",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-10013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inclusive ABA NM LLC
• Industrial Rehabilitation Clinics, PC
• Kelly Isler, RPH
• Samuel Basiaka Itie, FNP-C
• Ivy League Counseling LLC
• Jack L Graham, MD, PC
• Holly M Jackson,, B.S.
• Brandon Jacobi, PHARMD
• Alan R Jakins, MD
• James E Lankford DDS PA

• Clinical Social Worker in Roswell, NM
• Providers in Roswell, NM by specialty
• Clinical Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; 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.

Verify at the official NPI Registry.