Individual provider Active NPI

Anne Dutilh

  • Clinical Social Worker
  • Charlottesville, VA
National Provider Identifier
1518624931
Registry record updated Nov 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904013478 Issued in VA
Practice address
172 S Pantops Dr Ste C
Charlottesville, VA 22911-8672
Phone
(434) 218-0226
NPI assigned
Nov 19, 2021
Last updated
Nov 19, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2021

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 0904013478 VA Primary

Addresses

Primary practice location

172 S Pantops Dr Ste C
Charlottesville, VA 22911-8672

Mailing address

172 S Pantops Dr Ste C
Charlottesville, VA 22911-8672

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20220225000033 VA Practitioner - Clinical Social Worker 6901290535 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverbend Integrative Trauma TreatmentGroup PAC ID 8628489044, 10 clinicians

Practice addresses (Care Compare)

172 S Pantops Dr
Suite C
Charlottesville, VA 22911-8672
Phone (434) 961-2555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904013478VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Riverbend Integrative Trauma Treatment CurrentSince Feb 1, 2022 Accepting new patients

Locations

172 S Pantops Dr
#C
Charlottesville, VA 22911
Phone (434) 249-1304

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637280000000",
    "number": "1518624931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 S PANTOPS DR STE C",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229118672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 S PANTOPS DR STE C",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229118672",
            "telephone_number": "434-218-0226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTILH",
        "first_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-19",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904013478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

Verify at the official NPI Registry.