Individual provider Active NPI

Kimberly R Hazen, MSW, LCSW

  • Clinical Social Worker
  • Round Rock, TX
National Provider Identifier
1194149062
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
106814 Issued in TX
Practice address
2000 S Mays St Ste 201
Round Rock, TX 78664-7580
Phone
(512) 244-4272
Fax
(512) 244-2895
NPI assigned
Feb 12, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X CW017885 PA
Clinical Social Worker 1041C0700X CW017885 PA
Clinical Social Worker 1041C0700X 106814 TX Primary

Addresses

Primary practice location

2000 S Mays St Ste 201
Round Rock, TX 78664-7580

Mailing address

101 W Louis Henna Blvd Ste 300
Austin, TX 78728-1203
Phone (512) 244-4272

Other names 1

  • Kimberly R Hazen Kriebel Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20230906003059 TX Practitioner - Clinical Social Worker 4688060866 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mark Malone MD PAGroup PAC ID 2567369424, 102 clinicians

Practice addresses (Care Compare)

2000 S Mays St
Suite 201
Round Rock, TX 78664-7580
Phone (512) 244-4272

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CW017885PAMDClinical Social Worker
106814TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Malone, MD PA CurrentSince Aug 22, 2023 Accepting new patients
Mark Malone MD PA CurrentSince Aug 22, 2023 Accepting new patients
Life Management Inc Mental Health PastSince Jan 1, 1996 Accepting new patients

Locations

1901 Medi Park Dr
Ste 2
Amarillo, TX 79106
Phone (806) 350-7918

101 W Louis Henna Blvd
Ste 300
Austin, TX 78728

6000 S Mopac Expy
Ste 100
Austin, TX 78749

1106 College St
Ste C
Bastrop, TX 78602
Phone (512) 244-2895

2000 S Mays St
Ste 201
Round Rock, TX 78664
Phone (512) 492-3743

Interoperability endpoints

  • Direct secure messaging: kimberly.hazen.1@24201.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": "1392163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1194149062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W LOUIS HENNA BLVD STE 300",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787281203",
            "telephone_number": "512-244-4272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S MAYS ST STE 201",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786647580",
            "telephone_number": "512-244-4272",
            "fax_number": "512-244-2895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZEN",
        "first_name": "KIMBERLY",
        "middle_name": "R",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-12",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": "CW017885",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW017885",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "106814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "HAZEN KRIEBEL",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Round Rock, TX

Sources for this page

Verify at the official NPI Registry.