Individual provider Active NPI

James V Drake, LCSW

  • Clinical Social Worker
  • Green Bay, WI
National Provider Identifier
1245326172
Registry record updated Apr 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
3078123 Issued in WI
Practice address
300 Crooks Street
Green Bay, WI 54305-2308
Phone
(920) 436-6800
Fax
(920) 432-5966
NPI assigned
Oct 5, 2006
Last updated
Apr 22, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2009

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 3078123 WI Primary

Addresses

Primary practice location

300 Crooks Street
Green Bay, WI 54305-2308

Mailing address

300 Crooks Street
PO Box 22308
Green Bay, WI 54305-2308
Phone (920) 436-6800

Other identifiers 1

IdentifierTypeStateIssuer
39639700MedicaidWI

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
I20080808000814 WI Practitioner - Clinical Social Worker 9638243629 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

Practice addresses (Care Compare)

300 Crooks St
Green Bay, WI 54301-4527
Phone (920) 436-6800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3078123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Family Services of Northeast Wisconsin Inc Current Accepting new patients
Family Services of Northeast Wisconsin Inc CurrentSince Nov 1, 2009 Accepting new patients

Locations

300 Crooks St
Green Bay, WI 54301
Phone (920) 436-6800

1810 Appleton Rd
Menasha, WI 54952
Phone (920) 739-4226

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": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240358400000",
    "number": "1245326172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CROOKS STREET",
            "address_2": "PO BOX 22308",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052308",
            "telephone_number": "920-436-6800",
            "fax_number": "920-432-5966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CROOKS STREET",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052308",
            "telephone_number": "920-436-6800",
            "fax_number": "920-432-5966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAKE",
        "first_name": "JAMES",
        "middle_name": "V",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2009-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "3078123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39639700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.