Individual provider Active NPI

Carolyn Presnall, LCSW

  • Clinical Social Worker
  • Fort Worth, TX
National Provider Identifier
1134512601
Registry record updated Aug 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
00199 Issued in TX
Practice address
3840 Hulen St
HTN, Client Accounting
Fort Worth, TX 76107-7277
Phone
(817) 569-4300
NPI assigned
Mar 9, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2015

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 00199 TX Primary

Addresses

Primary practice location

3840 Hulen St
HTN, Client Accounting
Fort Worth, TX 76107-7277

Mailing address

PO Box 2603
HTN, Client Accounting
Fort Worth, TX 76113-2603
Phone (817) 569-4300

Other identifiers 3

IdentifierTypeStateIssuer
345091801MedicaidTX
89892QOtherTXBCBS
345091802MedicaidTX

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
I20150414001810 TX Practitioner - Clinical Social Worker 9436477874 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.99 of 100Reported as group
Quality
80
Improvement activities
40
Cost
66.63

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00199TXMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Supportive Care LLC CurrentSince Aug 1, 2016 Accepting new patients
My Health My Resources of Tarrant County CurrentSince Feb 21, 2015 Accepting new patients
Shine Medical Providers PC Past Accepting new patients

Locations

27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951

3840 Hulen St
Ft Worth, TX 76107
Phone (817) 569-4395

825 W Kearney St
Mesquite, TX 75149
Phone (972) 288-7660

Organizations & group practices 3

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": "1425859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439164800000",
    "number": "1134512601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2603",
            "address_2": "HTN, CLIENT ACCOUNTING",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761132603",
            "telephone_number": "817-569-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 HULEN ST",
            "address_2": "HTN, CLIENT ACCOUNTING",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077277",
            "telephone_number": "817-569-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESNALL",
        "first_name": "CAROLYN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-09",
        "last_updated": "2015-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "00199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "345091801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "89892Q",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "345091802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.