Individual provider Active NPI

Bethany Sandstrom, ISW18043

  • Clinical Social Worker
  • Clermont, FL
National Provider Identifier
1306600598
Registry record updated Feb 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ISW18043 Issued in FL
Practice address
210 N Highway 27 Ste 4
Clermont, FL 34711-2411
Phone
(352) 708-6283
NPI assigned
Feb 8, 2024
Last updated
Feb 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2024

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 ISW18043 FL Primary

Addresses

Primary practice location

210 N Highway 27 Ste 4
Clermont, FL 34711-2411

Mailing address

210 N Highway 27 Ste 4
Clermont, FL 34711-2411
Phone (352) 708-6283

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20241213000777 FL Practitioner - Clinical Social Worker 5597291534 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family Life Counseling CenterGroup PAC ID 0648623835, 13 clinicians

Practice addresses (Care Compare)

210 N Hwy 27
Suite 4
Clermont, FL 34711-2411
Phone (352) 708-6283

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ISW18043FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Family Life Counseling Center CurrentSince Oct 10, 2024 Accepting new patients

Locations

210 N US Highway 27
Ste 4
Clermont, FL 34711
Phone (352) 243-4800

858 S Duncan Dr
Tavares, FL 32778
Phone (352) 609-5103

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707350400000",
    "number": "1306600598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N HIGHWAY 27 STE 4",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112411",
            "telephone_number": "352-708-6283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N HIGHWAY 27 STE 4",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112411",
            "telephone_number": "352-708-6283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDSTROM",
        "first_name": "BETHANY",
        "credential": "ISW18043",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-08",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "ISW18043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

Verify at the official NPI Registry.