Individual provider Active NPI

Susan Hanks, LCSW

  • Clinical Social Worker
  • Poplar Bluff, MO
National Provider Identifier
1497935258
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2007027916 Issued in MO
Practice address
3001 Warrior LN
Poplar Bluff, MO 63901-8685
Phone
(573) 686-1200
Fax
(573) 686-1029
NPI assigned
Nov 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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 2007027916 MO Primary

Addresses

Primary practice location

3001 Warrior LN
Poplar Bluff, MO 63901-8685

Mailing address

3001 Warrior LN
Poplar Bluff, MO 63901-8685
Phone (573) 686-1200

Other identifiers 2

IdentifierTypeStateIssuer
11795658OtherCAQH
494476104MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20090610000127 MO Practitioner - Clinical Social Worker 4688724891 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family Counseling Center IncGroup PAC ID 2163410481, 39 clinicians

Practice addresses (Care Compare)

3001 Warrior LN
Poplar Bluff, MO 63901-8685
Phone (573) 686-1200

3025 Warrior Lane
Poplar Bluff, MO 63901-8685
Phone (573) 686-1200

925 Hwy VV
Kennett, MO 63857-0071
Phone (573) 888-5925

BLDG 925 Hwy VV
Kennett, MO 63857-0071
Phone (573) 888-5925

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2007027916MOMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Family Counseling Center, Inc. CurrentSince Apr 25, 2009 Accepting new patients
Family Counseling Center, Inc. CurrentSince Apr 25, 2009 Accepting new patients

Locations

3001 Warrior Ln
Poplar Bluff, MO 63901
Phone (573) 785-7453

1140 Three Rivers Blvd
Poplar Bluff, MO 63901

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": "1194566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1497935258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 WARRIOR LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639018685",
            "telephone_number": "573-686-1200",
            "fax_number": "573-686-1029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 WARRIOR LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639018685",
            "telephone_number": "573-686-1200",
            "fax_number": "573-686-1029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANKS",
        "first_name": "SUSAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-09",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2007027916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11795658",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "494476104",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.