Individual provider Active NPI

James P Schroeder, LCSW

  • Clinical Social Worker
  • Evansville, IN
National Provider Identifier
1417909912
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34000743A Issued in IN
Practice address
2330 Lynch Rd Ste 100
Evansville, IN 47711-2998
Phone
(812) 477-7246
NPI assigned
May 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 35000337A IN
Clinical Social Worker 1041C0700X 34000743A IN Primary

Addresses

Primary practice location

2330 Lynch Rd Ste 100
Evansville, IN 47711-2998

Mailing address

1101 Professional Blvd Ste 100
Evansville, IN 47714-8018
Phone (812) 477-7246

Other practice location 1

1101 Professional Blvd
Evansville, IN 47714-8016
Phone (812) 477-7246

Other identifiers 2

IdentifierTypeStateIssuer
000000363386OtherINANTHEM
673579OtherINHEALTHLINK

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20070517000551 IN Practitioner - Clinical Social Worker 7416054929 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1975
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

1101 Professional Blvd
Suite 100
Evansville, IN 47714-8018
Phone (812) 477-7246

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34000743AINMDClinical Social Worker
35000337AINMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pain Management Centers of America, PSC CurrentSince Jan 1, 2019 Accepting new patients

Locations

1101 Professional Blvd
Evansville, IN 47714
Phone 81247772461041

2330 Lynch Rd
Ste 100
Evansville, IN 47711
Phone (812) 867-9800

1101 Professional Blvd
Ste 100
Evansville, IN 47714
Phone (812) 573-1207

67 Lakeview Dr
Paducah, KY 42001
Phone (270) 554-8373

Organizations & group practices 1

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1417909912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 PROFESSIONAL BLVD STE 100",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477148018",
            "telephone_number": "812-477-7246",
            "fax_number": "812-477-7240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 LYNCH RD STE 100",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477112998",
            "telephone_number": "812-477-7246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Professional Blvd",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477148016",
            "country_code": "US",
            "telephone_number": "812-477-7246",
            "fax_number": "812-477-7240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCHROEDER",
        "first_name": "JAMES",
        "middle_name": "P",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IN",
            "license": "35000337A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34000743A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000363386",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "673579",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.