Randall John Ambrosius, MSW CADCIII LCSW
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Wisconsin Rapids, WI
NPI 1487720769 · NPPES record last updated Jan 29, 2008
Key facts
- NPI
- 1487720769
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 1834 (WI)
- Practice address
- 2611 12TH St S
Mental Health Aoda Clinic
Wisconsin Rapids, WI 54494 - Phone
- (715) 421-8849
- Fax
- (715) 421-2266
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100525000436 | WI | Practitioner - Clinical Social Worker | 2668501933 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4186123 | WI | MD | Clinical Social Worker |
| 1834 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aspirus Stevens Point Hospital & Clinics, Inc. | Current |
Accepting new patients | |
| Aspirus Stevens Point Hospital & Clinics, Inc. | Current |
Accepting new patients | |
| Interim Hospice & Palliative Care | Past | Accepting new patients |
Locations
29980 Network Pl
Chicago, IL 60673
900 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500
3398 E Maria Dr
Stevens Point, WI 54481
Phone (715) 341-7441
Interoperability endpoints
- https://fhir.meditouchehr.com/api/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1834 | WI | Yes |
| Clinical Social Worker | 1041C0700X | 4186123 | WI |
Addresses
Primary practice location
2611 12TH St S
Mental Health Aoda Clinic
Wisconsin Rapids, WI 54494
Mailing address
2611 12TH St S
Wisconsin Rapids, WI 54494
Phone (715) 421-8849
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39354800 | Medicaid | WI |
Other providers in Wisconsin Rapids, WI
- William Scott Akey
- Ma Lourdes Mauricio Akyurt
- Anthony Hugo Alde
- Grace Alnes
- Alpine Home Medical LLC
- Megan Amundson
- Bethany Lee Anderson
- Donna J Anderson
- Jaimie Jo Anderson
- Andrea M Bertotto, D.D.S., S.C.
All providers in Wisconsin Rapids, WI · Addiction (Substance Use Disorder) Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.