Individual provider Active NPI

Gina Marie Makouske, CSW

  • Social Worker
  • Salt Lake City, UT
National Provider Identifier
1487220224
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
12236527-3502 Issued in UT
Practice address
660 S 200 E
Salt Lake City, UT 84111-3835
Phone
(801) 359-2256
NPI assigned
Jun 2, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 12236527-3502 UT Primary

Addresses

Primary practice location

660 S 200 E
Salt Lake City, UT 84111-3835

Mailing address

660 S 200 E
Salt Lake City, UT 84111-3835

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20230111002507 TX Practitioner - Clinical Social Worker 8729458542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Confederated Tribes of the Goshute Reservation 58 clinicians

Practice addresses (Care Compare)

660 S 200 E
250 Sacred Cir Hlthcare
Salt Lake City, UT 84111-3846
Phone (801) 395-2256

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12236527-3502UTMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Confederated Tribes of the Goshute Reservation CurrentSince Nov 14, 2022 Accepting new patients
Confederated Tribes of the Goshute Reservation CurrentSince Nov 14, 2022 Accepting new patients

Locations

195 Tribal Center Rd
Ibapah, UT 84034
Phone (435) 234-1302

660 S 200 E
Slc, UT 84111
Phone (801) 355-1528

660 S 200 E
Ste 250
Slc, UT 84111
Phone (801) 395-2256

Organizations & group practices 2

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": "1622592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1487220224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S 200 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841113835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 S 200 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841113835",
            "telephone_number": "801-359-2256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAKOUSKE",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "credential": "CSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-02",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "12236527-3502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.