Individual provider Active NPI

Susan E Soares, MSW, LCSW

  • Clinical Social Worker
  • Indianapolis, IN
National Provider Identifier
1447550272
Registry record updated Feb 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34006853A Issued in IN
Practice address
5638 Professional Cir
Indianapolis, IN 46241-5042
Phone
(317) 247-8900
Fax
(317) 247-8935
NPI assigned
Oct 27, 2010
Reactivated
Feb 26, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2014

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 34006853A IN Primary

Addresses

Primary practice location

5638 Professional Cir
Indianapolis, IN 46241-5042

Mailing address

5638 Professional Cir
Indianapolis, IN 46241-5042
Phone (317) 247-8900

Other names 1

  • Susan Hunter Former name

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
I20140513000118 IN Practitioner - Clinical Social Worker 5092948356 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Indiana Medical College, School of Medicine of Purdue University, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Extended Care Specialists, IncGroup PAC ID 2466407713, 295 clinicians

Practice addresses (Care Compare)

8398 Mississippi St
FL 2
Merrillville, IN 46410-6316
Phone (855) 743-2247

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34006853AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Extended Care Specialists, Inc Clinical CurrentSince May 1, 2024 Accepting new patients

Locations

3512 Stellhorn Rd
Fort Wayne, IN 46815

8398 Mississippi St
Fl 2
Merrillville, IN 46410

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": "1288137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393372800000",
    "number": "1447550272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5638 PROFESSIONAL CIR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462415042",
            "telephone_number": "317-247-8900",
            "fax_number": "317-247-8935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5638 PROFESSIONAL CIR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462415042",
            "telephone_number": "317-247-8900",
            "fax_number": "317-247-8935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOARES",
        "first_name": "SUSAN",
        "middle_name": "E",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-27",
        "last_updated": "2014-02-26",
        "deactivation_date": "2013-12-11",
        "reactivation_date": "2014-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34006853A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "HUNTER",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.