Individual provider Active NPI

Deanna Marie Sack, LSCSW, LCP

  • Clinical Social Worker
  • Overland Park, KS
National Provider Identifier
1417027004
Registry record updated Nov 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
4580 Issued in KS
Practice address
7501 College Blvd.
Suite 250
Overland Park, KS 66210-1944
Phone
(913) 451-8550
Fax
(913) 469-5266
NPI assigned
Nov 9, 2006
Last updated
Nov 5, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 282 KS
Clinical Social Worker 1041C0700X 4580 KS Primary

Addresses

Primary practice location

7501 College Blvd.
Suite 250
Overland Park, KS 66210-1944

Mailing address

7501 College Blvd.
Suite 250
Overland Park, KS 66210-1944
Phone (913) 451-8550

Other identifiers 2

IdentifierTypeStateIssuer
27192036OtherMOBCBS OF KC
27192036OtherKSBCBS OF KC

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
4580KSMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225843200000",
    "number": "1417027004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7501 COLLEGE BLVD.",
            "address_2": "SUITE 250",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662101944",
            "telephone_number": "913-451-8550",
            "fax_number": "913-469-5266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7501 COLLEGE BLVD.",
            "address_2": "SUITE 250",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662101944",
            "telephone_number": "913-451-8550",
            "fax_number": "913-469-5266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SACK",
        "first_name": "DEANNA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LSCSW, LCP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2008-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KS",
            "license": "282",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "4580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KC",
            "identifier": "27192036",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KC",
            "identifier": "27192036",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.