Individual provider Active NPI

Mandi Goretska, LMSW

  • Clinical Social Worker
  • Abilene, TX
National Provider Identifier
1255620548
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
1502 N 1St St
Abilene, TX 79601-5602
Phone
(325) 672-9999
Fax
(325) 672-5237
NPI assigned
Apr 7, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 079646 IA
Clinical Social Worker 1041C0700X Primary
Counselor 101Y00000X

Addresses

Primary practice location

1502 N 1St St
Abilene, TX 79601-5602

Mailing address

1679 128TH St
Corydon, IA 50060-8803
Phone (641) 344-7330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20240621001275 TX Practitioner - Clinical Social Worker 1355752817 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
First Baptist Mission Action IncGroup PAC ID 7214959121, 7 clinicians

Practice addresses (Care Compare)

1502 N 1St St
Abilene, TX 79601-5602
Phone (325) 672-9999

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
079646IAMDMental Health Counselor
68872TXMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
First Baptist Mission Action Inc Mental Health CurrentSince Apr 14, 2024 Accepting new patients

Locations

1502 N 1st St
Abilene, TX 79601
Phone (325) 672-9999

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": "1302134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1255620548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1679 128TH ST",
            "city": "CORYDON",
            "state": "IA",
            "postal_code": "500608803",
            "telephone_number": "641-344-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 N 1ST ST",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796015602",
            "telephone_number": "325-672-9999",
            "fax_number": "325-672-5237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORETSKA",
        "first_name": "MANDI",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-07",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "079646",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Abilene, TX

Sources for this page

Verify at the official NPI Registry.