Individual provider Active NPI

James W. Backlund, LCSW

  • Clinical Social Worker
  • Fresno, CA
National Provider Identifier
1295847515
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS11805 Issued in CA
Practice address
1060 W Sierra Ave Ste 105
Fresno, CA 93711-2063
Phone
(559) 437-1111
Fax
(559) 437-1118
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 LCS11805 CA Primary

Addresses

Primary practice location

1060 W Sierra Ave Ste 105
Fresno, CA 93711-2063

Mailing address

1060 W Sierra Ave Ste 105
Fresno, CA 93711-2063
Phone (559) 437-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20050817000837 CA Practitioner - Clinical Social Worker 8921038142 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS11805CAMDClinical Social Worker
11805CAMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
County of Fresno CurrentSince Aug 21, 2000 Accepting new patients
County of Fresno Clinical CurrentSince Aug 21, 2000 Accepting new patients

Locations

4441 E Kings Canyon Rd
Fresno, CA 93702
Phone (559) 453-4099

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295847515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 W SIERRA AVE STE 105",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937112063",
            "telephone_number": "559-437-1111",
            "fax_number": "559-437-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 W SIERRA AVE STE 105",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937112063",
            "telephone_number": "559-437-1111",
            "fax_number": "559-437-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACKLUND",
        "first_name": "JAMES",
        "middle_name": "W.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS11805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.