Active NPI
Edmund Shane Kasner, LCSW, MSW, MAM
- Clinical Social Worker
- Riverside, CA
National Provider Identifier
1144346818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS6737
- Practice address
- 5015 Canyon Crest Dr
Suite 105
Riverside, CA 92507-6000 - Phone
- (951) 276-0696
- Fax
- (951) 276-0885
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS6737 | CA | Primary |
Addresses
Primary practice location
5015 Canyon Crest Dr
Suite 105
Riverside, CA 92507-6000
Mailing address
5015 Canyon Crest Drive
Suite 105
Riverside, CA 92507
Phone (951) 276-0696
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 188407 | Medicaid | CA | |
| 33BFO9 | Medicaid | CA | |
| 33BFA9 | Medicaid | CA | |
| LCS067370 | Other | CA | BLUE SHIELD PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS6737 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1144346818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5015 CANYON CREST DRIVE",
"address_2": "SUITE 105",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "92507",
"telephone_number": "951-276-0696",
"fax_number": "951-276-0885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5015 CANYON CREST DR",
"address_2": "SUITE 105",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925076000",
"telephone_number": "951-276-0696",
"fax_number": "951-276-0885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KASNER",
"first_name": "EDMUND",
"middle_name": "SHANE",
"credential": "LCSW, MSW, MAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS6737",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "188407",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33BFO9",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33BFA9",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PIN",
"identifier": "LCS067370",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.