Susan Marie Gambach, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149015516 Issued in IL

Practice address

1514 Country Lake Dr
Champaign, IL 61821-6428

Phone

(217) 637-1537

NPI assigned

Oct 24, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• S. Marie Gambach Professional name

Medicare fee-for-service enrollment

Enrolled in IL

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, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351036800000",
    "number": "1164775458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 N CHESTNUT ST",
            "address_2": "SUITE 243",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618204039",
            "telephone_number": "217-637-1537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 COUNTRY LAKE DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618216428",
            "telephone_number": "217-637-1537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBACH",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-24",
        "last_updated": "2012-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149015516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION LICENSE NUMBER",
            "identifier": "149015516",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "S.",
            "last_name": "GAMBACH",
            "middle_name": "MARIE",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Emma Gadhiya
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• Erin M Galen, LSW
• Maria Gabrielle Gallanosa, RN
• Rajul Gandhi, PHARM.D.
• Samantha Gannon, RBT
• Trevon Gant, RBT
• Luis E Garcia Tillan
• Karla Maria Garcia-Digioia, M.D.

• Clinical Social Worker in Champaign, IL
• Providers in Champaign, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2012; 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.