Individual provider Active NPI

Laura Beth Ross, LCSW

  • Clinical Social Worker
  • Phoenix, AZ
National Provider Identifier
1467917377
Registry record updated Feb 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-17422 Issued in AZ
Practice address
6601 W Thomas Rd
Phoenix, AZ 85033-5700
Phone
(602) 243-7277
NPI assigned
Feb 5, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 7, 2019

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 LCSW-17422 AZ Primary

Addresses

Primary practice location

6601 W Thomas Rd
Phoenix, AZ 85033-5700

Mailing address

5161 W Riviera Dr
Glendale, AZ 85304-1990
Phone (443) 858-5507

Other names 1

  • Laura Beth Fultonberger Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20190306000562 AZ Practitioner - Clinical Social Worker 3971842154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain Park Health CenterGroup PAC ID 8325949647, 117 clinicians

Practice addresses (Care Compare)

6601 W Thomas Rd
Phoenix, AZ 85033-5700
Phone (602) 243-7277

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW-17422AZMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Park Health Center CurrentSince Feb 25, 2019 Accepting new patients
Mountain Park Health Center Current Accepting new patients
Mountain Park Health Center CurrentSince Feb 25, 2019 Accepting new patients

Locations

635 E Baseline Rd
Phoenix, AZ 85042

2702 N 3rd St
Ste 4020
Phoenix, AZ 85004
Phone (602) 323-3345

6601 W Thomas Rd
Phoenix, AZ 85033

3003 N Central Ave
Ste 1600
Phoenix, AZ 85012
Phone (602) 323-3492

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": "1549324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549497600000",
    "number": "1467917377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5161 W RIVIERA DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853041990",
            "telephone_number": "443-858-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 W THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850335700",
            "telephone_number": "602-243-7277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "LAURA",
        "middle_name": "BETH",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-05",
        "last_updated": "2019-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-17422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "FULTONBERGER",
            "middle_name": "BETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.