Individual provider Active NPI

Rosa C Correa

  • Clinical Social Worker
  • San Jose, CA
National Provider Identifier
1417231192
Registry record updated Mar 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
76434 Issued in CA
Practice address
160 E Virginia St
Suite 280
San Jose, CA 95112-5857
Phone
(408) 287-6200
Fax
(408) 998-1535
NPI assigned
Sep 29, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 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 76434 CA Primary

Addresses

Primary practice location

160 E Virginia St
Suite 280
San Jose, CA 95112-5857

Mailing address

160 E Virginia St
Suite 280
San Jose, CA 95112-5857
Phone (408) 287-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20200212002645 CA Practitioner - Clinical Social Worker 2860828720 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
76434CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Gardner Family Health Network Inc CurrentSince Dec 18, 2019 Accepting new patients
Gardner Family Health Network, Inc. CurrentSince Dec 18, 2019 Accepting new patients

Locations

160 E Virginia St
Ste 100
San Jose, CA 95112
Phone (408) 918-2618

160 E Virginia St
Ste 280
San Jose, CA 95112
Phone (408) 457-7100

Organizations & group practices 2

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": "1317254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1417231192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 E VIRGINIA ST",
            "address_2": "SUITE 280",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951125857",
            "telephone_number": "408-287-6200",
            "fax_number": "408-998-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E VIRGINIA ST",
            "address_2": "SUITE 280",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951125857",
            "telephone_number": "408-287-6200",
            "fax_number": "408-998-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORREA",
        "first_name": "ROSA",
        "middle_name": "C",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-29",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "76434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.