Sandra Jean Mathes, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

169-C Issued in AR

Practice address

210 N Shamrock Blvd
Russellville, AR 72802

Phone

(501) 303-3105

NPI assigned

Sep 9, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

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, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Youth Home IncGroup PAC ID 4789806431, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/youthhome/r4/

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.

• Youth Home Inc

  • Psychiatric Residential Treatment Facility
  • Little Rock, AR
  • NPI 1942266879
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1154570604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N SHAMROCK BLVD",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728029658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N SHAMROCK BLVD",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "72802",
            "telephone_number": "501-303-3105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Dons Way",
            "address_purpose": "LOCATION",
            "city": "Hot Springs",
            "state": "AR",
            "postal_code": "719136478",
            "country_code": "US",
            "telephone_number": "501-624-7111",
            "fax_number": "501-620-5109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHES",
        "first_name": "SANDRA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-09",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "169-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116399726",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Massage by Catherine LLC
• Chastity Massengale
• Virgil R. Massey Jr., M.D.
• Chadwick Jerold Masters, M.D.
• Ashley Mateos, LPC
• Elizabeth Mathis
• Maxus Inc
• William Alan Maxwell-Walker, APRN
• Leigh Alexandria Maxwell
• Jessica May

• Clinical Social Worker in Russellville, AR
• Providers in Russellville, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; 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.