Individual provider Active NPI

Susan E Wilden, LISW

  • Clinical Social Worker
  • San Antonio, TX
National Provider Identifier
1235485301
Registry record updated Jul 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
00835 Issued in IA
Practice address
7272 Wurzbach Rd
601
San Antonio, TX 78240-4801
Phone
(210) 615-3483
Fax
(210) 593-9863
NPI assigned
Jul 26, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2012

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 00835 IA Primary

Addresses

Primary practice location

7272 Wurzbach Rd
601
San Antonio, TX 78240-4801

Mailing address

7272 Wurzbach Rd
601
San Antonio, TX 78240-4801
Phone (210) 615-3483

Other identifiers 1

IdentifierTypeStateIssuer
00835OtherIALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20121017000135 IA Practitioner - Clinical Social Worker 9032369640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deer Oaks Mental Health Associates PCGroup PAC ID 2264337013, 55 clinicians

Practice addresses (Care Compare)

407 S E Ave
Baxter, IA 50028-1013
Phone (641) 227-3602

4130 Northwest Blvd
Davenport, IA 52806-4243
Phone (563) 391-3430

Merit-based Incentive Payment System (MIPS)

Final score
91.16 of 100Reported as group
Quality
80.99
Improvement activities
40
Cost
72.05

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Deer Oaks Mental Health Associates PC CurrentSince Aug 6, 2012 Accepting new patients

Locations

407 S East Ave
Baxter, IA 50028
Phone (641) 227-3602

7272 Wurzbach Rd
Ste 601
San Antonio, TX 78240
Phone (210) 615-3472

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343260800000",
    "number": "1235485301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7272 WURZBACH RD",
            "address_2": "601",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782404801",
            "telephone_number": "210-615-3483",
            "fax_number": "210-593-9863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7272 WURZBACH RD",
            "address_2": "601",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782404801",
            "telephone_number": "210-615-3483",
            "fax_number": "210-593-9863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDEN",
        "first_name": "SUSAN",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-26",
        "last_updated": "2012-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "00835",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "00835",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.