Thomas Gwynne Wales, MSW LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14061 Issued in MN

Practice address

627 Snelling Ave S
Suite 200
Saint Paul, MN 55116-1590

Phone

(651) 699-1062

NPI assigned

Jun 17, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Clinical Social Worker

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Thomas Wales, MSW, Licsw

  • Clinical Social Worker
  • Saint Paul, MN
  • NPI 1063534469
  NPD (past) Authorized official
• River City Mental Health Clinic, P.a.

  • Clinical Psychologist
  • Saint Paul, MN
  • NPI 1558348078
  NPD (past)

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371513600000",
    "number": "1245491877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 SNELLING AVE. S",
            "address_2": "SUITE 200",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "55116",
            "telephone_number": "651-699-1062",
            "fax_number": "651-699-1084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 SNELLING AVE S",
            "address_2": "SUITE 200",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551161590",
            "telephone_number": "651-699-1062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALES",
        "first_name": "THOMAS",
        "middle_name": "GWYNNE",
        "name_prefix": "Mr.",
        "credential": "MSW LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-17",
        "last_updated": "2013-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "14061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MINNESOTA CLINIC ID",
            "identifier": "090H8WA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MINNESOTA PROVIDER ID",
            "identifier": "090H8WA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "444260100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Pick Wald, M.S. C.C.C.
• Lori Wald, R.N.
• Waldhaven Mental Health PLLC
• Margaret Walech
• Jessica Lee Walek
• Douglas Glen Walesheck, D.D.S.
• Matthew Daniel Walfoort, BA , LADC
• Walgreen Co (Walgreens #07388)
• Walgreen Co (Walgreens # 16476)
• Walgreen Co (Walgreens #02355)

• Clinical Social Worker in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.