Individual provider Active NPI

John Fishburn, LISW

  • Counselor
  • Wooster, OH
National Provider Identifier
1538658802
Registry record updated May 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
I1800831 Issued in OH
Practice address
104 Spink St
Wooster, OH 44691-3652
Phone
(330) 264-8498
NPI assigned
May 2, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X I1800831 OH Primary

Addresses

Primary practice location

104 Spink St
Wooster, OH 44691-3652

Mailing address

104 Spink St
Wooster, OH 44691-3652
Phone (330) 264-8498

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20180710003578 OH Practitioner - Clinical Social Worker 7911253661 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I1800831OHMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Oneeighty, Inc. CurrentSince May 28, 2018 Accepting new patients
Oneeighty, Inc. CurrentSince May 28, 2018 Accepting new patients

Locations

104 Spink St
Wooster, OH 44691
Phone (330) 264-8498

128 E Milltown Rd
Ste 202
Wooster, OH 44691
Phone (330) 264-8498

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": "1525219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525219200000",
    "number": "1538658802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 SPINK ST",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446913652",
            "telephone_number": "330-264-8498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 SPINK ST",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446913652",
            "telephone_number": "330-264-8498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHBURN",
        "first_name": "JOHN",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-02",
        "last_updated": "2018-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "I1800831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wooster, OH

Sources for this page

Verify at the official NPI Registry.