Individual provider Active NPI

Randy G. Shaffner, MSW, LCSW

  • Clinical Social Worker
  • Colorado Springs, CO
National Provider Identifier
1447308507
Registry record updated Feb 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
984077 Issued in CO
Practice address
128 E Monument St Ste 201
Colorado Springs, CO 80903-1062
Phone
(719) 633-7819
Fax
(719) 477-9692
NPI assigned
Jan 8, 2007
Last updated
Feb 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2022

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 984077 CO Primary

Addresses

Primary practice location

128 E Monument St Ste 201
Colorado Springs, CO 80903-1062

Mailing address

128 E Monument St Ste 201
Colorado Springs, CO 80903-1062
Phone (719) 633-7819

Other identifiers 1

IdentifierTypeStateIssuer
056368MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20090324000368 CO Practitioner - Clinical Social Worker 6103983846 Practice locations: Colorado Springs, CO

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

128 E Monument St
Suite 201
Colorado Springs, CO 80903-4717
Phone (719) 633-7819

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
984077COMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644624000000",
    "number": "1447308507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 E MONUMENT ST STE 201",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809031062",
            "telephone_number": "719-633-7819",
            "fax_number": "719-477-9692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 E MONUMENT ST STE 201",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809031062",
            "telephone_number": "719-633-7819",
            "fax_number": "719-477-9692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFNER",
        "first_name": "RANDY",
        "middle_name": "G.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2022-02-12",
        "certification_date": "2022-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "984077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "056368",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.