Active NPI
Michael Waidner Hill, LISW
- Clinical Social Worker
- Espanola, NM
National Provider Identifier
1306163316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I-0088
- Practice address
- 2010 Industrial Park Rd
Espanola, NM 87532-3600 - Phone
- (505) 753-7395
- Fax
- (505) 753-8373
- NPI assigned
- Apr 29, 2010
- Last updated
- Aug 10, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I-0088 | NM | Primary |
Addresses
Primary practice location
2010 Industrial Park Rd
Espanola, NM 87532-3600
Mailing address
P.O. Box 158
620 N Coronado Ave
Espanola, NM 87532-0238
Phone (505) 753-7218
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 91585 | Medicaid | NM | |
| NM100915 | Other | NM | MEDICARE PTAN |
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 |
|---|---|---|---|
| I-0088 | NM | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| El Centro Family Health | Past | Accepting new patients | |
| El Centro Family Health | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Federally Qualified Health Center (FQHC)
- Wagon Mound, NM
- NPI 1538324223
-
- Federally Qualified Health Center (FQHC)
- Espanola, NM
- NPI 1780689034
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312934400000",
"number": "1306163316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 158",
"address_2": "620 N CORONADO AVE",
"city": "ESPANOLA",
"state": "NM",
"postal_code": "875320238",
"telephone_number": "505-753-7218",
"fax_number": "505-753-5815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2010 INDUSTRIAL PARK RD",
"city": "ESPANOLA",
"state": "NM",
"postal_code": "875323600",
"telephone_number": "505-753-7395",
"fax_number": "505-753-8373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HILL",
"first_name": "MICHAEL",
"middle_name": "WAIDNER",
"name_prefix": "Mr.",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-04-29",
"last_updated": "2011-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "I-0088",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "91585",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "NM100915",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Espanola, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.