Individual provider Active NPI

David J Mikula, LCSW,CADC III,NCACII

  • Clinical Social Worker
  • Eugene, OR
National Provider Identifier
1386730968
Registry record updated May 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L3369 Issued in OR
Practice address
146 E 12TH Ave
Eugene, OR 97401-3513
Phone
(541) 342-8437
Fax
(541) 342-1639
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 31, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L3369 OR Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 930203 OR

Addresses

Primary practice location

146 E 12TH Ave
Eugene, OR 97401-3513

Mailing address

1258 High St
Eugene, OR 97401-3238

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20100317001130 OR Practitioner - Clinical Social Worker 3375678113 Practice locations: Eugene, OR

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

834 Pearl St
Suite 200
Eugene, OR 97401-2727
Phone (541) 359-7965

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
930203ORMDAddiction (Substance Use Disorder) Counselor
L3369ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Family Development, Inc. Addiction (Substance Use Disorder) Past Accepting new patients
Center for Family Development, Inc. Addiction (Substance Use Disorder) Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/c-f-d/r4/

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338422400000",
    "number": "1386730968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1258 HIGH ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 E 12TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013513",
            "telephone_number": "541-342-8437",
            "fax_number": "541-342-1639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKULA",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "LCSW,CADC III,NCACII",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2012-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L3369",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "930203",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

Verify at the official NPI Registry.