Active NPI
John Gallagher
- Social Worker
- South Bend, IN
National Provider Identifier
1265616346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 33006220A
- Practice address
- 415 E Madison St
South Bend, IN 46617-2322 - Phone
- (574) 283-1234
- Fax
- (574) 537-2652
- NPI assigned
- Dec 24, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 87001365A | IN | |
| Social Worker | 104100000X | 33006220A | IN | Primary |
Addresses
Primary practice location
415 E Madison St
South Bend, IN 46617-2322
Mailing address
PO Box 809
Goshen, IN 46527-0809
Phone (574) 533-1234
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 87001365A | IN | MD | Addiction (Substance Use Disorder) Counselor |
| 33006220A | IN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354147200000",
"number": "1265616346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 809",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465270809",
"telephone_number": "574-533-1234",
"fax_number": "574-537-2652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 E MADISON ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466172322",
"telephone_number": "574-283-1234",
"fax_number": "574-537-2652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLAGHER",
"first_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-24",
"last_updated": "2012-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IN",
"license": "87001365A",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IN",
"license": "33006220A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.