NPIMap

Individual provider Active NPI

Theresa A Brockman, LISW

  • Social Worker
  • Lebanon, OH
National Provider Identifier
1346618063
Registry record updated Nov 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
I1451226 Issued in OH
Practice address
1231 Columbus Ave Unit A1
Lebanon, OH 45036-8196
Phone
(513) 695-4495
Fax
(513) 228-1236
NPI assigned
Sep 11, 2015
Last updated
Nov 19, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X I1451226 OH Primary

Addresses

Primary practice location

1231 Columbus Ave Unit A1
Lebanon, OH 45036-8196

Mailing address

424 Wards Corner Rd Ste 200
Loveland, OH 45140-6966
Phone (513) 576-7700

Other identifiers 1

IdentifierTypeStateIssuer
0165638MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160303002233 OH Practitioner - Clinical Social Worker 9931405735 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I1451226OHMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Healthsource of Ohio, Inc. Current Accepting new patients
Healthsource of Ohio Inc Current Accepting new patients
Healthsource of Ohio, Inc. Current Accepting new patients
Healthsource of Ohio, Inc. Current Accepting new patients
Healthsource of Ohio Inc Current Accepting new patients
Healthsource of Ohio, Inc. CurrentSince Nov 22, 2021 Accepting new patients
Healthsource of Ohio, Inc. Current Accepting new patients
Healthsource of Ohio, Inc. CurrentSince Nov 22, 2021 Accepting new patients
Healthsource of Ohio, Inc. Current Accepting new patients
Healthsource of Ohio, Inc. Current Accepting new patients
Healthsource of Ohio, Inc. Current Accepting new patients
Healthsource of Ohio Inc Current Accepting new patients
Healthsource of Ohio, Inc. Current Accepting new patients
Butler County Community Health Consortium, Inc. Past Accepting new patients
Butler County Community Health Consortium, Inc. PastSince Oct 10, 2021 Accepting new patients
Healthsource of Ohio, Inc. Past Accepting new patients

Locations

1231 Columbus Ave
#1
Lebanon, OH 45036
Phone (513) 696-4495

1231 Columbus Ave
Unit A1
Lebanon, OH 45036
Phone (513) 695-4495

424 Wards Corner Rd
Ste 200
Loveland, OH 45140
Phone (513) 707-4041

Interoperability endpoints

  • Direct secure messaging: theresa.brockmanlisw.p1@direct.hsohio.nextgenshare.com

Organizations & group practices 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637280000000",
    "number": "1346618063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 WARDS CORNER RD STE 200",
            "city": "LOVELAND",
            "state": "OH",
            "postal_code": "451406966",
            "telephone_number": "513-576-7700",
            "fax_number": "513-576-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1231 COLUMBUS AVE UNIT A1",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450368196",
            "telephone_number": "513-695-4495",
            "fax_number": "513-228-1236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKMAN",
        "first_name": "THERESA",
        "middle_name": "A",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-11",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I1451226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0165638",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, OH

Sources for this page

Verify at the official NPI Registry.