Individual provider Active NPI

Jose Mathew

  • Clinical Social Worker
  • Colorado Springs, CO
National Provider Identifier
1447690474
Registry record updated Feb 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW.09925839 Issued in CO
Practice address
1795 Jet Wing Dr
Colorado Springs, CO 80916-2332
Phone
(719) 572-6100
NPI assigned
Jul 5, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X ACD.0001671 CO
Clinical Social Worker 1041C0700X CSW.09925839 CO Primary

Addresses

Primary practice location

1795 Jet Wing Dr
Colorado Springs, CO 80916-2332

Mailing address

220 Ruskin Dr
Colorado Springs, CO 80910-2522

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
I20190313000441 CO Practitioner - Clinical Social Worker 8921348871

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

220 Ruskin Dr
Colorado Springs, CO 80910-2522

66 E Flagler St
Miami, FL 33130-1807

7330 Owings PT
Peyton, CO 80831-4735

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ACD.0001671COMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Diversus Health Inc CurrentSince Feb 20, 2019 Accepting new patients
Diversus Health Inc CurrentSince Feb 20, 2019 Accepting new patients
Diversus Health Inc Current Accepting new patients

Locations

460 County Road 43
Ste 7
Bailey, CO 80421
Phone (303) 838-5013

328 10th St
Calhan, CO 80808

875 W Moreno Ave
Colorado Springs, CO 80905
Phone (719) 572-6200

179 S Parkside Dr
Colorado Springs, CO 80910
Phone (719) 572-6300

1795 Jet Wing Dr
Colorado Springs, CO 80916
Phone (719) 572-6111

6208 Lehman Dr
Colorado Springs, CO 80918
Phone (719) 572-6133

220 Ruskin Dr
Colorado Springs, CO 80910
Phone (719) 572-6150

413 Security Blvd
Colorado Springs, CO 80911

115 S Parkside Dr
Colorado Springs, CO 80910
Phone (719) 572-6340

18401 Highway 24
Ste 119
Woodland Park, CO 80863

Organizations & group practices 3

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": "1372982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1447690474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 RUSKIN DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809102522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1795 JET WING DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809162332",
            "telephone_number": "719-572-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "JOSE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-05",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "ACD.0001671",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09925839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.