Individual provider Active NPI

Kathleen Renee Mast, MSW, LCSW

  • Clinical Social Worker
  • Mishawaka, IN
National Provider Identifier
1275501355
Registry record updated Jan 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34001414A Issued in IN
Practice address
113 Lincolnway E
Mishawaka, IN 46544-2016
Phone
(574) 255-4976
NPI assigned
Mar 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 34001414A IN Primary

Addresses

Primary practice location

113 Lincolnway E
Mishawaka, IN 46544-2016

Mailing address

PO Box 1887
Elkhart, IN 46515-1887
Phone (574) 389-0542

Other identifiers 1

IdentifierTypeStateIssuer
000000391927OtherINANTHEM BCBS #

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20041202000554 IN Practitioner - Clinical Social Worker 8022074921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Indiana University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1750 Kilbourn St
Elkhart, IN 46514-1920
Phone (574) 266-8066

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34001414AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Michelle Thomas, LCSW, LLC Clinical CurrentSince Nov 1, 2021 Accepting new patients
Psych Pointe LLC PastSince Jan 7, 2024 Accepting new patients

Locations

1750 Kilbourn St
Elkhart, IN 46514
Phone (574) 266-8066

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24035/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1275501355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1887",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465151887",
            "telephone_number": "574-389-0542",
            "fax_number": "574-522-8505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 LINCOLNWAY E",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465442016",
            "telephone_number": "574-255-4976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAST",
        "first_name": "KATHLEEN",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34001414A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS #",
            "identifier": "000000391927",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.