Individual provider Active NPI

Andrew Powell Travis, LISW, LICDC

  • Clinical Social Worker
  • Columbus, OH
National Provider Identifier
1164614905
Registry record updated Aug 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I10062 Issued in OH
Practice address
1791 Alum Creek Dr
Columbus, OH 43207-1708
Phone
(614) 445-8131
Fax
(614) 324-5456
NPI assigned
Aug 15, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2007

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 I10062 OH Primary

Addresses

Primary practice location

1791 Alum Creek Dr
Columbus, OH 43207-1708

Mailing address

1791 Alum Creek Dr
Columbus, OH 43207-1708
Phone (614) 445-8131

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20201030000218 OH Practitioner - Clinical Social Worker 8123438298 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Behavioral Care of Ohio IncGroup PAC ID 7719325083, 67 clinicians

Practice addresses (Care Compare)

4624 Sawmill Rd
Columbus, OH 43220-2247
Phone (614) 459-4490

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I10062OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of Ohio, Inc CurrentSince Apr 1, 2024 Accepting new patients
Optum Behavioral Care of Ohio, Inc Current Accepting new patients
Optum Behavioral Care of Ohio, Inc. Clinical CurrentSince Apr 1, 2024 Accepting new patients

Locations

4624 Sawmill Rd
Columbus, OH 43220
Phone (614) 457-4490

3055 Kettering Blvd
Ste 218
Moraine, OH 45439
Phone (937) 813-1292

Interoperability endpoints

  • Direct secure messaging: andrew.travis.1@28621.direct.athenahealth.com

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": "1187136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187136000000",
    "number": "1164614905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1791 ALUM CREEK DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432071708",
            "telephone_number": "614-445-8131",
            "fax_number": "614-324-5456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1791 ALUM CREEK DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432071708",
            "telephone_number": "614-445-8131",
            "fax_number": "614-324-5456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVIS",
        "first_name": "ANDREW",
        "middle_name": "POWELL",
        "name_prefix": "Mr.",
        "credential": "LISW, LICDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-15",
        "last_updated": "2007-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I10062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.