Active NPI
Tracy Moore Funke, LSW
- Social Worker
- Lebanon, OH
National Provider Identifier
1346646098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S-1500383
- Practice address
- 975 Kingsview Dr
BLDG a
Lebanon, OH 45036-9562 - Phone
- (513) 228-7800
- Fax
- (513) 228-7846
- NPI assigned
- Nov 7, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | S-1500383 | OH | Primary |
Addresses
Primary practice location
975 Kingsview Dr
BLDG a
Lebanon, OH 45036-9562
Mailing address
204 Cook Rd
Suite 400
Lebanon, OH 45036-9600
Phone (513) 228-7800
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S-1500383 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443484800000",
"number": "1346646098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 COOK RD",
"address_2": "SUITE 400",
"city": "LEBANON",
"state": "OH",
"postal_code": "450369600",
"telephone_number": "513-228-7800",
"fax_number": "513-695-2952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "975 KINGSVIEW DR",
"address_2": "BLDG A",
"city": "LEBANON",
"state": "OH",
"postal_code": "450369562",
"telephone_number": "513-228-7800",
"fax_number": "513-228-7846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE FUNKE",
"first_name": "TRACY",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-07",
"last_updated": "2015-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S-1500383",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.