Individual provider Active NPI

Stephen E Prettyman, LISW

  • Clinical Social Worker
  • Fairfield, IA
National Provider Identifier
1417077264
Registry record updated Jun 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
06375 Issued in IA
Practice address
2154 125TH St
Fairfield, IA 52556-8962
Phone
(641) 919-2474
NPI assigned
Mar 29, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 11, 2026

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 06375 IA Primary

Addresses

Primary practice location

2154 125TH St
Fairfield, IA 52556-8962

Mailing address

2154 125TH St
Fairfield, IA 52556-8962
Phone (641) 919-2474

Other identifiers 2

IdentifierTypeStateIssuer
0066191MedicaidIA
59246OtherIABCBS OF IA GROUP #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20070801000680 IA Practitioner - Clinical Social Worker 0446341622 Reassigns benefits to 1 organization
Practice locations: Fairfield, IA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2154 125TH St
Fairfield, IA 52556-8962
Phone (641) 919-2474

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Optimae Lifeservices, Inc, Clinical CurrentSince Apr 21, 2016 Accepting new patients
Optimae Lifeservices,Inc. Current Accepting new patients
Nurse in the House, Inc. Past Accepting new patients
Enlumen, Inc. Past Accepting new patients

Locations

301 W Burlington Ave
Fairfield, IA 52556
Phone (641) 472-1684

2201 W Jefferson Ave
Fairfield, IA 52556
Phone (641) 472-1684

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": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781136000000",
    "number": "1417077264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2154 125TH ST",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525568962",
            "telephone_number": "641-919-2474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2154 125TH ST",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525568962",
            "telephone_number": "641-919-2474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRETTYMAN",
        "first_name": "STEPHEN",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "06375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0066191",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IA GROUP #",
            "identifier": "59246",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, IA

Sources for this page

Verify at the official NPI Registry.