Individual provider Active NPI

Lisa Mowbray, MSW

  • Clinical Social Worker
  • Portage, WI
National Provider Identifier
1205852886
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
677-123 Issued in WI
Practice address
2901 Hunters TRL
Portage, WI 53901-3403
Phone
(608) 742-5518
Fax
(608) 742-4087
NPI assigned
Jul 15, 2006
Last updated
Nov 1, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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 677 WI
Clinical Social Worker 1041C0700X 677-123 WI Primary

Addresses

Primary practice location

2901 Hunters TRL
Portage, WI 53901-3403

Mailing address

2901 Hunters TRL
Portage, WI 53901-3403
Phone (608) 742-5518

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
I20160425002020 WI Practitioner - Clinical Social Worker 5496054561 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Service Associates, SCGroup PAC ID 8426948746, 34 clinicians

Practice addresses (Care Compare)

2901 Hunters TRL
Portage, WI 53901-3403
Phone (608) 742-5518

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
677WIMDSocial Worker
677-123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health Cooperative of South Central Wisconsin CurrentSince Dec 18, 2016 Accepting new patients
Community Service Associates, SC CurrentSince Apr 7, 2016 Accepting new patients

Locations

1002 Lincoln Ave
Baraboo, WI 53913
Phone (608) 356-9055

2702 International Ln
Ste 102
Madison, WI 53704
Phone (608) 240-2280

675 W Washington Ave
Madison, WI 53703
Phone (608) 257-5178

8202 Excelsior Dr
Madison, WI 53717
Phone (608) 831-1766

2901 Hunters Trl
Portage, WI 53901
Phone (608) 742-5518

Organizations & group practices 2

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": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1205852886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 HUNTERS TRL",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539013403",
            "telephone_number": "608-742-5518",
            "fax_number": "608-742-4087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 HUNTERS TRL",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539013403",
            "telephone_number": "608-742-5518",
            "fax_number": "608-742-4087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOWBRAY",
        "first_name": "LISA",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-15",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "677",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "677-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, WI

Sources for this page

Verify at the official NPI Registry.