Active NPI
Edward John Whitacre, LCSW
- Clinical Social Worker
- Newport News, VA
National Provider Identifier
1417965583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904002390
- Practice address
- 11825 Rock Landing Dr
The James Building
Newport News, VA 23606-4236 - Phone
- (757) 873-1736
- Fax
- (757) 873-1028
- NPI assigned
- Aug 4, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904002390 | VA | Primary |
Addresses
Primary practice location
11825 Rock Landing Dr
The James Building
Newport News, VA 23606-4236
Mailing address
4657 Massena Dr
Williamsburg, VA 23188-1261
Phone (757) 566-4824
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
11825 Rock Landing Dr
Newport News, VA 23606-4236
Phone (757) 873-1736
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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- Newport News, VA
- NPI 1528159183
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417965583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4657 MASSENA DR",
"city": "WILLIAMSBURG",
"state": "VA",
"postal_code": "231881261",
"telephone_number": "757-566-4824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11825 ROCK LANDING DR",
"address_2": "THE JAMES BUILDING",
"city": "NEWPORT NEWS",
"state": "VA",
"postal_code": "236064236",
"telephone_number": "757-873-1736",
"fax_number": "757-873-1028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITACRE",
"first_name": "EDWARD",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904002390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport News, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.