Individual provider Active NPI

Annie Forbes Lane

  • Social Worker
  • Portsmouth, OH
National Provider Identifier
1205358009
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
S.1903661 Issued in OH
Practice address
902 Gallia St
Portsmouth, OH 45662-4139
Phone
(740) 529-2125
NPI assigned
Jul 13, 2017
Last updated
May 13, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X BP00942485 WV
Social Worker 104100000X S.1903661 OH Primary

Addresses

Primary practice location

902 Gallia St
Portsmouth, OH 45662-4139

Mailing address

PO Box 396
Springboro, OH 45066-0396

Other practice location 1

705 Washington St
Ravenswood, WV 26164-1729
Phone (304) 868-6000

Other practice location 2

1418 MacCorkle Ave SW Ste A
Charleston, WV 25303-1331
Phone (304) 348-1288

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
I20260427000569 OH Practitioner - Clinical Social Worker 6608343785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1634 11TH St
Portsmouth, OH 45662-4526

9425 Delegates Row
Indianapolis, IN 46240-3805

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S.1903661OHMDSocial Worker
BP00942485WVMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Group Home, LLC PastSince May 16, 2022 Accepting new patients
Phoenix Group Home, LLC PastSince May 16, 2022 Accepting new patients
Path Integrated Healthcare - WV LLC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/pathihc/r4/

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": "1499904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652400000000",
    "number": "1205358009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 396",
            "city": "SPRINGBORO",
            "state": "OH",
            "postal_code": "450660396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 GALLIA ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456624139",
            "telephone_number": "740-529-2125"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 Washington St",
            "address_purpose": "LOCATION",
            "city": "Ravenswood",
            "state": "WV",
            "postal_code": "261641729",
            "country_code": "US",
            "telephone_number": "304-868-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1418 MacCorkle Ave SW Ste A",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253031331",
            "country_code": "US",
            "telephone_number": "304-348-1288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANE",
        "first_name": "ANNIE",
        "middle_name": "FORBES",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-13",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WV",
            "license": "BP00942485",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1903661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, OH

Sources for this page

Verify at the official NPI Registry.