Individual provider Active NPI

Amy M Spurgeon, LCSW

  • Clinical Social Worker
  • Elkhart, IN
National Provider Identifier
1548201320
Registry record updated Nov 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34004945A Issued in IN
Practice address
2600 Oakland Ave
Elkhart, IN 46517-1533
Phone
(574) 533-1234
Fax
(574) 537-2652
NPI assigned
Jun 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2011

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 34004945A IN Primary

Addresses

Primary practice location

2600 Oakland Ave
Elkhart, IN 46517-1533

Mailing address

PO Box 809
Goshen, IN 46527-0809
Phone (574) 533-1234

Other identifiers 1

IdentifierTypeStateIssuer
000000391800OtherINANTHEM PIN NUMBER

Other names 1

  • Amy M Brewers Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20110426000737 IN Practitioner - Clinical Social Worker 6608051156 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34004945AINMDClinical Social Worker

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321833600000",
    "number": "1548201320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 809",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465270809",
            "telephone_number": "574-533-1234",
            "fax_number": "574-537-2652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 OAKLAND AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465171533",
            "telephone_number": "574-533-1234",
            "fax_number": "574-537-2652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPURGEON",
        "first_name": "AMY",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2011-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34004945A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM  PIN NUMBER",
            "identifier": "000000391800",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "BREWERS",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Elkhart, IN

Sources for this page

Verify at the official NPI Registry.