Individual provider Active NPI

Kai Stoll

  • Clinical Social Worker
  • Wantagh, NY
National Provider Identifier
1407332042
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
094558 Issued in NY
Practice address
34 Willowood Dr
Wantagh, NY 11793-1217
Phone
(516) 532-8889
NPI assigned
Jul 17, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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 094558 NY Primary
Social Worker 104100000X NY

Addresses

Primary practice location

34 Willowood Dr
Wantagh, NY 11793-1217

Mailing address

34 Willowood Dr
Wantagh, NY 11793-1217
Phone (516) 532-8889

Other practice location 1

114 Church St
Freeport, NY 11520-3833
Phone (516) 868-3030 ext. 2242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20230202001802 NY Practitioner - Clinical Social Worker 6406228352 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
094558NYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
South Shore Child Association Incorporated CurrentSince Jan 1, 2023 Accepting new patients
Epilepsy Foundation of L.I. CurrentSince Jan 1, 2023 Accepting new patients
Epic Long Island CurrentSince Jan 1, 2023 Accepting new patients
South Shore Child Association Incorporated CurrentSince Jan 1, 2023 Accepting new patients

Locations

1500 Hempstead Tpke
East Meadow, NY 11554
Phone 51673977331420

114 Church St
Freeport, NY 11520
Phone (516) 868-3030

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": "1531785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1407332042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 WILLOWOOD DR",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117931217",
            "telephone_number": "516-532-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 WILLOWOOD DR",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117931217",
            "telephone_number": "516-532-8889"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "114 Church St",
            "address_purpose": "LOCATION",
            "city": "Freeport",
            "state": "NY",
            "postal_code": "115203833",
            "country_code": "US",
            "telephone_number": "516-868-3030 x2242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOLL",
        "first_name": "KAI",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-17",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "094558",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wantagh, NY

Sources for this page

Verify at the official NPI Registry.