Brandylyn S Bristow, LCSW
Individual provider Active NPI Clinical Social Worker · Owensville, MO
NPI 1154630770 · NPPES record last updated Feb 20, 2012
Key facts
- NPI
- 1154630770
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 20080000932 (MO)
- Practice address
- 708 East Highway 28
Owensville, MO 65066 - Phone
- (573) 486-1193
- Fax
- (573) 486-0910
- NPI assigned
- Sep 30, 2010
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hermann Area Hospital District
Practice addresses (Care Compare)
509 W 18TH St
Hermann, MO 65041-1547
Phone (573) 486-2191
509 W 18TH St PO Box
Suite 470
Hermann, MO 65041-1547
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240430000528 | MO | Practitioner - Clinical Social Worker | 6608216262 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20080000932 | MO | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hermann Area Hospital District | Current |
Accepting new patients | |
| Hermann Area Hospital District | Current |
Accepting new patients | |
| Hermann Area Hospital District | Past | Accepting new patients |
Locations
509 W 18th St
Hermann, MO 65041
Phone (573) 486-2045
123 Bavarian Hills Plz
Hermann, MO 65041
Phone (573) 486-2118
504 N Sturgeon St
Montgomery City, MO 63361
Phone (573) 564-2990
708 E Highway 28
Owensville, MO 65066
Phone (573) 437-4481
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/f62890b5-77ff-44bd-a981-0a0981047b35/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 20080000932 | MO | Yes |
Addresses
Primary practice location
708 East Highway 28
Owensville, MO 65066
Mailing address
2591 Fowler Road
Hermann, MO 65041
Phone (573) 943-9973
Other providers in Owensville, MO
- Rhonda Bohl
- Madeline Grace Borgerding
- Payton Grace Boyd
- Renee Brandon
- Bethany D Breeden Smith
- Medro Joseph Brodeur III
- Wayne Karlton Brown
- Elizabeth Ann Bruemmer
- Mary Brune
- Stacy Lynn Caldwell
All providers in Owensville, MO · Clinical Social Worker in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.