Active NPI
Christine Martha Koontz
- Clinical Social Worker
- Chino, CA
National Provider Identifier
1215550611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 21942
- Practice address
- 4091 Riverside Dr Ste 214
Chino, CA 91710-6502 - Phone
- (909) 255-0791
- NPI assigned
- May 20, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 21942 | CA | Primary |
Addresses
Primary practice location
4091 Riverside Dr Ste 214
Chino, CA 91710-6502
Mailing address
4091 Riverside Dr Ste 214
Chino, CA 91710-6502
Phone (909) 255-0791
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 18, 2023 through Oct 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589932800000",
"number": "1215550611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4091 RIVERSIDE DR STE 214",
"city": "CHINO",
"state": "CA",
"postal_code": "917106502",
"telephone_number": "909-255-0791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4091 RIVERSIDE DR STE 214",
"city": "CHINO",
"state": "CA",
"postal_code": "917106502",
"telephone_number": "909-255-0791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOONTZ",
"first_name": "CHRISTINE",
"middle_name": "MARTHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-20",
"last_updated": "2020-05-20",
"certification_date": "2020-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "21942",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.