Active NPI
Judy H Prochaska, MSW
- Clinical Social Worker
- Davenport, IA
National Provider Identifier
1295782175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 01160
- Practice address
- 2101 E 38TH St
Davenport, IA 52807 - Phone
- (563) 359-4049
- Fax
- (563) 359-4069
- NPI assigned
- May 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 01160 | IA | Primary |
Addresses
Primary practice location
2101 E 38TH St
Davenport, IA 52807
Mailing address
2101 E 38TH St
Davenport, IA 52807
Phone (563) 359-4049
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1108750000 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2102 E 38TH St
Davenport, IA 52807-1135
Phone (563) 359-4049
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01160 | IA | MD | Physical Therapy Assistant |
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.
-
- Psychologist
- Davenport, IA
- NPI 1629090675
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366243200000",
"number": "1295782175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 E 38TH ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "52807",
"telephone_number": "563-359-4049",
"fax_number": "563-359-4069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 E 38TH ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "52807",
"telephone_number": "563-359-4049",
"fax_number": "563-359-4069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCHASKA",
"first_name": "JUDY",
"middle_name": "H",
"name_prefix": "Mrs.",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-27",
"last_updated": "2013-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IA",
"license": "01160",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1108750000",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Davenport, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; 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.