Active NPI
Mary M Bragg, LCSW
- Clinical Social Worker
- Champaign, IL
National Provider Identifier
1245822063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 309 W Clark St
Champaign, IL 61820-4637 - Phone
- (217) 398-9066
- Fax
- (217) 398-9077
- NPI assigned
- Feb 4, 2021
- 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 | Primary |
Addresses
Primary practice location
309 W Clark St
Champaign, IL 61820-4637
Mailing address
309 W Clark St
Champaign, IL 61820-4637
Phone (217) 398-9066
Other names 1
- Mary M O'Malley
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2001 Philo Rd
Urbana, IL 61802-8007
Phone (217) 398-9066
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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.
-
- Mental Health Counselor
- Urbana, IL
- NPI 1255357422
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612396800000",
"number": "1245822063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 W CLARK ST",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618204637",
"telephone_number": "217-398-9066",
"fax_number": "217-398-9077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 W CLARK ST",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618204637",
"telephone_number": "217-398-9066",
"fax_number": "217-398-9077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAGG",
"first_name": "MARY",
"middle_name": "M",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-04",
"last_updated": "2021-02-04",
"certification_date": "2021-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "O'MALLEY",
"middle_name": "M",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; 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.