Individual provider Active NPI

Shoshanna Everhart, MSW

  • Clinical Social Worker
  • Shelbyville, IN
National Provider Identifier
1336147099
Registry record updated Oct 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34003554A Issued in IN
Practice address
15 S Tompkins St
Shelbyville, IN 46176-1205
Phone
(317) 392-0171
Fax
(317) 392-0171
NPI assigned
Jul 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2017

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 34003554A IN Primary

Addresses

Primary practice location

15 S Tompkins St
Shelbyville, IN 46176-1205

Mailing address

30 W Rampart St Ste 200
Shelbyville, IN 46176-8846
Phone (317) 421-2012

Other identifiers 1

IdentifierTypeStateIssuer
200057860MedicaidIN

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

LicenseStateTypeSpecialty
34003554AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Major Hospital Past Accepting new patients
Blue River Counseling Associates Inc Clinical 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509408000000",
    "number": "1336147099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 W RAMPART ST STE 200",
            "city": "SHELBYVILLE",
            "state": "IN",
            "postal_code": "461768846",
            "telephone_number": "317-421-2012",
            "fax_number": "317-398-1852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S TOMPKINS ST",
            "city": "SHELBYVILLE",
            "state": "IN",
            "postal_code": "461761205",
            "telephone_number": "317-392-0171",
            "fax_number": "317-392-0171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERHART",
        "first_name": "SHOSHANNA",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2017-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34003554A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200057860",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelbyville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.