Organization Active NPI

Martha Ann Brandt, Inc

  • Clinical Social Worker
  • Evansville, IN
National Provider Identifier
1467752071
Registry record updated Oct 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
IN34002417A Issued in IN
Legal business name
MARTHA ANN BRANDT, INC
Practice address
4770 Covert Ave
Suite 230
Evansville, IN 47714-5617
Phone
(812) 449-4006
Fax
(812) 475-3470
NPI assigned
Oct 28, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2010

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

Authorized official

Name
Martha Ann Brandt, LCSWNPI 1114900412
Title
Licensed Clinical Social Worker
Phone
(812) 449-4006

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X IN34002417A IN Primary

Addresses

Primary practice location

4770 Covert Ave
Suite 230
Evansville, IN 47714-5617

Mailing address

4770 Covert Ave
Suite 230
Evansville, IN 47714-5617
Phone (812) 449-4006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101102001405 IN Part B Supplier - Clinic/Group Practice 1456545532 Receives reassigned benefits from 1 practitioner
Practice locations: Evansville, IN

National Provider Directory

National Provider Directory

Locations

4770 Covert Ave
Ste 230
Evansville, IN 47714
Phone (812) 449-4006

4770 Covert Ave
Ste 223
Evansville, IN 47714
Phone (812) 431-3896

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288224000000",
    "number": "1467752071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4770 COVERT AVE",
            "address_2": "SUITE 230",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477145617",
            "telephone_number": "812-449-4006",
            "fax_number": "812-475-3470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4770 COVERT AVE",
            "address_2": "SUITE 230",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477145617",
            "telephone_number": "812-449-4006",
            "fax_number": "812-475-3470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTHA ANN BRANDT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-28",
        "last_updated": "2010-10-28",
        "status": "A",
        "authorized_official_last_name": "BRANDT",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "812-449-4006",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "IN34002417A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.