Individual provider Active NPI

Leslie M McDonald-Gonzalez, LISW

  • Clinical Social Worker
  • Sioux City, IA
National Provider Identifier
1528148103
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
06057 Issued in IA
Practice address
625 Court St
Sioux City, IA 51101-1919
Phone
(712) 252-3871
Fax
(712) 252-3157
NPI assigned
Oct 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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 06057 IA Primary

Addresses

Primary practice location

625 Court St
Sioux City, IA 51101-1919

Mailing address

625 Court St
Sioux City, IA 51101-1919
Phone (712) 252-3871

Other identifiers 1

IdentifierTypeStateIssuer
0092080MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20140131000537 IA Practitioner - Clinical Social Worker 4688777006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Siouxland Mental Health Services IncGroup PAC ID 4688575251, 30 clinicians

Practice addresses (Care Compare)

625 Court St
Sioux City, IA 51101-1919
Phone (712) 252-3871

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Siouxland Community Health Center CurrentSince Oct 9, 2013 Accepting new patients
Siouxland Mental Health Services, Inc. Clinical CurrentSince Nov 18, 2017 Accepting new patients

Locations

625 Court St
Sioux City, IA 51101
Phone (712) 252-3871

1021 Nebraska St
Sioux City, IA 51105
Phone (712) 252-2477

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": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1528148103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 COURT ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011919",
            "telephone_number": "712-252-3871",
            "fax_number": "712-252-3157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 COURT ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011919",
            "telephone_number": "712-252-3871",
            "fax_number": "712-252-3157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD-GONZALEZ",
        "first_name": "LESLIE",
        "middle_name": "M",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "06057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0092080",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

Verify at the official NPI Registry.