Individual provider Active NPI

Martha Tell York, MSW, LCSW

  • Clinical Social Worker
  • Madison, WI
National Provider Identifier
1174745988
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
7097123 Issued in WI
Practice address
5 Odana Court
Madison, WI 53562
Phone
(608) 270-6614
Fax
(608) 277-0448
NPI assigned
May 2, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 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 7097123 WI Primary

Addresses

Primary practice location

5 Odana Court
Madison, WI 53562

Mailing address

4872 Highwood Circle
Middleton, WI 53562
Phone (608) 335-2007

Other identifiers 1

IdentifierTypeStateIssuer
40976500MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20100727000414 WI Practitioner - Clinical Social Worker 0648303792 Practice locations: Madison, WI

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1999
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

715 Hill St
Suite 250C
Madison, WI 53705-3572
Phone (608) 335-2007

9401 Kahl Rd
Black Earth, WI 53515-9518

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7097123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Peter C. Jackson, PSYD Consulting, SC CurrentSince May 21, 2016 Accepting new patients

Locations

700 Ray O Vac Dr
Ste 220
Madison, WI 53711
Phone (608) 276-9191

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174745988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4872 HIGHWOOD CIRCLE",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "53562",
            "telephone_number": "608-335-2007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 ODANA COURT",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53562",
            "telephone_number": "608-270-6614",
            "fax_number": "608-277-0448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YORK",
        "first_name": "MARTHA",
        "middle_name": "TELL",
        "name_prefix": "Ms.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7097123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40976500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.