Agnes Cecilia Osterholt-Polston, MSW,LCSWS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34002679A Issued in IN

Practice address

4235 Flagstaff Cove
Fort Wayne, IN 46815

Phone

(260) 969-6600

Fax

(260) 969-6601

NPI assigned

Jul 30, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bridges Emotional Wellness Clinic, Inc

  • Clinical Social Worker
  • Fort Wayne, IN
  • NPI 1437375888
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406764800000",
    "number": "1255346011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4235 FLAGSTAFF COVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46815",
            "telephone_number": "260-969-6600",
            "fax_number": "260-969-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 FLAGSTAFF COVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46815",
            "telephone_number": "260-969-6600",
            "fax_number": "260-969-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSTERHOLT-POLSTON",
        "first_name": "AGNES",
        "middle_name": "CECILIA",
        "credential": "MSW,LCSWS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-30",
        "last_updated": "2014-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34002679A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Osenga, PHARMD
• Mark A Oshaughnessy, MD
• Osita Victor Ezeakudo MD PC
• Hany Osman, M.D.
• Ossip Optometry, PC
• Kenda C Osterholt
• Princess Ostine, OD
• Daniel M Ostlund
• Emilee Ott, RBT
• J. Andrew Ott, MSW, LCSW

• Clinical Social Worker in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; 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.