Individual provider Active NPI

Kayona Pates, MSW

  • Counselor
  • South Bend, IN
National Provider Identifier
1225674781
Registry record updated Jan 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
415 E Madison St
South Bend, IN 46617-2322
Phone
(574) 533-1234
Fax
(574) 537-2652
NPI assigned
Nov 20, 2019
Last updated
Jan 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary

Addresses

Primary practice location

415 E Madison St
South Bend, IN 46617-2322

Mailing address

PO Box 809
Goshen, IN 46527-0809
Phone (574) 533-1234

Other names 1

  • Kayona Blackwood Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20231205000834 IN Practitioner - Clinical Social Worker 5799133559 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Oaklawn Psychiatric Center, Inc. CurrentSince Oct 23, 2023 Accepting new patients
Oaklawn Psychiatric Center, Inc. CurrentSince Oct 23, 2023 Accepting new patients

Locations

2600 Oakland Ave
Elkhart, IN 46517
Phone (574) 283-1234

330 Lakeview Dr
Goshen, IN 46528
Phone (219) 533-1234

415 E Madison St
South Bend, IN 46617
Phone (574) 283-1234

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": "1574208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578614400000",
    "number": "1225674781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 809",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465270809",
            "telephone_number": "574-533-1234",
            "fax_number": "574-537-2652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E MADISON ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172322",
            "telephone_number": "574-533-1234",
            "fax_number": "574-537-2652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATES",
        "first_name": "KAYONA",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-20",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYONA",
            "last_name": "BLACKWOOD",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.