Individual provider Active NPI

Simon Rabas

  • Clinical Social Worker
  • Sturgeon Bay, WI
National Provider Identifier
1306360201
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
911 Green Bay Rd Ste 103
Sturgeon Bay, WI 54235-3814
Phone
(920) 743-5566
NPI assigned
Aug 1, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2025

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 Primary

Addresses

Primary practice location

911 Green Bay Rd Ste 103
Sturgeon Bay, WI 54235-3814

Mailing address

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone (920) 746-0510

Other practice location 1

323 S 18th Ave
Sturgeon Bay, WI 54235-1401
Phone (920) 746-0510

Other identifiers 1

IdentifierTypeStateIssuer
APPLIEDMedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20220321002433 WI Practitioner - Clinical Social Worker 2860887205 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Door County Memorial HospitalGroup PAC ID 5395735088, 85 clinicians

Practice addresses (Care Compare)

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone (920) 743-5566

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Door County Memorial Hospital CurrentSince Mar 28, 2022 Accepting new patients
Door County Memorial Hospital CurrentSince Mar 28, 2022 Accepting new patients
Counseling Associates of Door County, LLC Past Accepting new patients

Locations

911 Green Bay Rd
Ste 103
Sturgeon Bay, WI 54235
Phone (920) 743-5566

323 S 18th Ave
Sturgeon Bay, WI 54235
Phone (920) 743-5566

Organizations & group practices 3

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": "1501545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746489600000",
    "number": "1306360201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 S 18TH AVE",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351401",
            "telephone_number": "920-746-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 GREEN BAY RD STE 103",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542353814",
            "telephone_number": "920-743-5566"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "323 S 18th Ave",
            "address_purpose": "LOCATION",
            "city": "Sturgeon Bay",
            "state": "WI",
            "postal_code": "542351401",
            "country_code": "US",
            "telephone_number": "920-746-0510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RABAS",
        "first_name": "SIMON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-01",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "APPLIED",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturgeon Bay, WI

Sources for this page

Verify at the official NPI Registry.