Carissa Sandoval, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34009167A Issued in IN

Practice address

480 Eversman Dr
Jasper, IN 47546-3548

Phone

(812) 482-3020

NPI assigned

Sep 2, 2021

Last updated

Sep 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifespring, Inc

  dba Southern Indiana Mental Health and Guidance Center of ECI

  • Community/Behavioral Health Agency
  • Jeffersonville, IN
  • NPI 1851489942
  Medicare reassignment NPD
• Lifespring, Inc

  • Community/Behavioral Health Agency
  • Jasper, IN
  • NPI 1487121687
  NPD
• Lifespring, Inc

  dba LifeSpring Health Systems

  • Community/Behavioral Health Agency
  • Dale, IN
  • NPI 1639029283
  NPD
• Lifespring Inc.

  dba Jasper Community Medical Services

  • Federally Qualified Health Center (FQHC)
  • Jasper, IN
  • NPI 1023681889
  NPD (past)

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

{
    "created_epoch": "1630540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1417625542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 EVERSMAN DR",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475463548",
            "telephone_number": "812-482-3020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 EVERSMAN DR",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475463548",
            "telephone_number": "812-482-3020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "CARISSA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-02",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34009167A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "3700-03-6622",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carissa.sandoval@lifespringhealthsysems.org",
            "affiliation": "N",
            "endpointDescription": "E-mail",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "E-mail",
            "address_1": "480 Eversman Dr",
            "city": "Jasper",
            "state": "IN",
            "country_code": "US",
            "postal_code": "475463548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephen Curry Sample, M.D.
• Melinda Sams, L.C.S.W.
• Maisie Noelle Ricafort Sancho, RPT
• Elizabeth Ann Sanders, FNP-C
• Alfredo Sandoval
• Phaedra Lynn Savage, RBT
• Elizabeth Saylor, RBT
• Dawn Rene Schauberger, RPH
• Katlyn Cecilia Schehr
• Stacia Lynn Schiefer, M.S. CCC-SLP

• Clinical Social Worker in Jasper, IN
• Providers in Jasper, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.