Individual provider Active NPI

Sandra Jean King, MSSW, LCSW

  • Clinical Social Worker
  • Dallas, TX
National Provider Identifier
1275805301
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
50490 Issued in TX
Practice address
6363 Forest Park Rd.
Dallas, TX 75390-9121
Phone
(214) 648-8500
Fax
(214) 645-3775
NPI assigned
Feb 6, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

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 50490 TX Primary

Addresses

Primary practice location

6363 Forest Park Rd.
Dallas, TX 75390-9121

Mailing address

PO Box 845347
Dallas, TX 75284-5347
Phone (214) 645-0624

Other identifiers 1

IdentifierTypeStateIssuer
50490OtherTXTEXAS STATE BOARD OF SOCIAL WORKER EXAMINERS

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
I20120424000444 TX Practitioner - Clinical Social Worker 4587826318 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Assurasource LTDGroup PAC ID 8123125580, 61 clinicians

Practice addresses (Care Compare)

400 N Allen Dr
Allen, TX 75013-2568
Phone (972) 233-1010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
50490TXMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Assurasource LTD Clinical CurrentSince Feb 9, 2012 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince May 1, 2017 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince May 1, 2017 Accepting new patients

Locations

400 N Allen Dr
Ste 204
Allen, TX 75013

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

5303 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390
Phone (214) 645-2300

Organizations & group practices 4

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": "1328486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1275805301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 845347",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752845347",
            "telephone_number": "214-645-0624",
            "fax_number": "214-645-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6363 FOREST PARK RD.",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753909121",
            "telephone_number": "214-648-8500",
            "fax_number": "214-645-3775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "SANDRA",
        "middle_name": "JEAN",
        "credential": "MSSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-06",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "50490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE BOARD OF SOCIAL WORKER EXAMINERS",
            "identifier": "50490",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.