Individual provider Active NPI

Michelle Renae Johnson, LCSW

  • Clinical Social Worker
  • Connellsville, PA
National Provider Identifier
1497707764
Registry record updated May 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CW014499 Issued in PA
Practice address
1051 Morrell Ave
Connellsville, PA 15425-3958
Phone
(724) 437-0729
Fax
(724) 437-2761
NPI assigned
May 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2017

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 CW014499 PA Primary

Addresses

Primary practice location

1051 Morrell Ave
Connellsville, PA 15425-3958

Mailing address

100 New Salem Rd
Suite 116
Uniontown, PA 15401-8936
Phone (724) 437-0729

Other identifiers 2

IdentifierTypeStateIssuer
1430686OtherHIGHMARK
001931501MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20041208000178 PA Practitioner - Clinical Social Worker 9234195561 Practice locations: Dunbar, PA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1259 University Dr
Dunbar, PA 15431-2305
Phone (724) 317-3796

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CW014499PAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494288000000",
    "number": "1497707764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 NEW SALEM RD",
            "address_2": "SUITE 116",
            "city": "UNIONTOWN",
            "state": "PA",
            "postal_code": "154018936",
            "telephone_number": "724-437-0729",
            "fax_number": "724-437-2761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 MORRELL AVE",
            "city": "CONNELLSVILLE",
            "state": "PA",
            "postal_code": "154253958",
            "telephone_number": "724-437-0729",
            "fax_number": "724-437-2761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICHELLE",
        "middle_name": "RENAE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2017-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW014499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "1430686",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001931501",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Connellsville, PA

Sources for this page

Verify at the official NPI Registry.