Individual provider Active NPI

Charles L Shivley

  • Clinical Social Worker
  • Oak Ridge, TN
National Provider Identifier
1407330244
Registry record updated Sep 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
240 W Tyrone Rd
Oak Ridge, TN 37830-6517
Phone
(865) 482-1076
NPI assigned
Sep 18, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2018

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 Primary

Addresses

Primary practice location

240 W Tyrone Rd
Oak Ridge, TN 37830-6517

Mailing address

240 W Tyrone Rd
Oak Ridge, TN 37830-6517

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, KY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20181031003262 TN Practitioner - Clinical Social Worker 5294088647 Reassigns benefits to 1 organization
I20221027002393 KY Practitioner - Clinical Social Worker 5294088647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Tennessee, HSC, College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psychological and Behavioral Consultants LLCGroup PAC ID 0446243760, 595 clinicians

Practice addresses (Care Compare)

100 Executive Park
Suite 103
Louisville, KY 40207-4201
Phone (502) 552-5068

1030 Monarch St
Suite 100
Lexington, KY 40513-1820
Phone (844) 468-5050

120 Prosperous PL
Suite 201
Lexington, KY 40509-1866
Phone (216) 468-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Healthcare Services CurrentSince Dec 9, 2019 Accepting new patients
Alliance Healthcare Services Clinical CurrentSince Dec 9, 2019 Accepting new patients
Psychological & Behavioral Consultants, LLC Clinical CurrentSince Dec 1, 2022 Accepting new patients
Mental Health Centers & Clinics of Tennessee PastSince Aug 20, 2018 Accepting new patients

Locations

161 Prosperous Pl
Ste 100
Lexington, KY 40509
Phone (859) 214-7440

120 Prosperous Pl
Ste 201
Lexington, KY 40509
Phone (859) 368-0609

100 Executive Park
Ste 103
Louisville, KY 40207
Phone (502) 313-6880

25101 Chagrin Blvd
Ste 100
Beachwood, OH 44122
Phone (216) 245-4468

2579 Douglass Ave
Memphis, TN 38114
Phone (901) 369-1418

3810 Winchester Rd
Memphis, TN 38118
Phone (901) 369-1400

2220 Union Ave
Memphis, TN 38104
Phone (901) 369-1480

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1407330244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W TYRONE RD",
            "city": "OAK RIDGE",
            "state": "TN",
            "postal_code": "378306517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W TYRONE RD",
            "city": "OAK RIDGE",
            "state": "TN",
            "postal_code": "378306517",
            "telephone_number": "865-482-1076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVLEY",
        "first_name": "CHARLES",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-18",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Ridge, TN

Sources for this page

Verify at the official NPI Registry.