Individual provider Active NPI

Tracey L Johnson, L.I.S.W.-CP

  • Clinical Social Worker
  • Rock Hill, SC
National Provider Identifier
1396816385
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6970 Issued in SC
Practice address
150 Oakland Ave
Rock Hill, SC 29730-4073
Phone
(803) 334-4056
NPI assigned
Nov 13, 2006
Last updated
Aug 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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 6970 SC Primary

Addresses

Primary practice location

150 Oakland Ave
Rock Hill, SC 29730-4073

Mailing address

PO Box 36144
Rock Hill, SC 29732-0502
Phone (803) 334-4056

Other identifiers 2

IdentifierTypeStateIssuer
570629234006OtherSCBCBS
CJ5560OtherSCRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20101112000963 SC Practitioner - Clinical Social Worker 2062607518 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Brody School of Medicine at East Carolina University, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

150 Oakland Ave
Suite 200
Rock Hill, SC 29730-4068
Phone (803) 334-4056

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Stepping Stones Counesling Services,LLC Clinical CurrentSince Sep 11, 2010 Accepting new patients
TL Johnson Counseling Services, LLC CurrentSince Aug 21, 2023 Accepting new patients
Premier Chiropractic, LLC PastSince Apr 12, 2010 Accepting new patients
The Saluda Counseling Services Center Inc. Clinical PastSince Apr 16, 2001 Accepting new patients

Locations

1450 Ebenezer Rd
Rock Hill, SC 29732
Phone (803) 817-7837

150 Oakland Ave
Ste 200
Rock Hill, SC 29730
Phone (803) 334-4056

2241 Ebenezer Rd
Rock Hill, SC 29732
Phone (803) 366-7778

Organizations & group practices 4

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1396816385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36144",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297320502",
            "telephone_number": "803-334-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 OAKLAND AVE",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297304073",
            "telephone_number": "803-334-4056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TRACEY",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "L.I.S.W.-CP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "6970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "570629234006",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ5560",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Hill, SC

Sources for this page

Verify at the official NPI Registry.