Individual provider Active NPI

Amy R Sommer, MSW

  • Clinical Social Worker
  • Waltham, MA
National Provider Identifier
1194872507
Registry record updated Sep 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
P003241 Issued in NC
Practice address
1430 Main St
Waltham, MA 02451-1623
Phone
(781) 647-5327
Fax
(617) 419-6603
NPI assigned
Jan 5, 2007
Last updated
Sep 10, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2018

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 P003241 NC Primary

Addresses

Primary practice location

1430 Main St
Waltham, MA 02451-1623

Mailing address

411 W Chapel Hill St
Suite 908
Durham, NC 27701-3616
Phone (919) 419-3474

Other practice location 1

411 W Chapel Hill St
Suite 908
Durham, NC 27701-3616
Phone (919) 419-3474 ext. 371

Other identifiers 1

IdentifierTypeStateIssuer
P003241OtherNCPROVISIONAL LCSW LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20260411000192 MA Practitioner - Clinical Social Worker 3072088681 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2004
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

399 Revolution Dr
Somerville, MA 02145-1444

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P003241NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Past Accepting new patients
Child and Parent Support Services Clinical Past Accepting new patients

Organizations & group practices 4

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": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536537600000",
    "number": "1194872507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 W CHAPEL HILL ST",
            "address_2": "SUITE 908",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277013616",
            "telephone_number": "919-419-3474",
            "fax_number": "919-419-9353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 MAIN ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511623",
            "telephone_number": "781-647-5327",
            "fax_number": "617-419-6603"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "411 W Chapel Hill St",
            "address_2": "Suite 908",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277013616",
            "country_code": "US",
            "telephone_number": "919-419-3474 x371",
            "fax_number": "919-419-9353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOMMER",
        "first_name": "AMY",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2018-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P003241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVISIONAL LCSW LICENSE",
            "identifier": "P003241",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

Verify at the official NPI Registry.