NPIMap

Organization Active NPI

Making a Difference Support Services

  • Clinical Social Worker
  • Fairbanks, AK
National Provider Identifier
1558715391
Registry record updated Apr 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1053 Issued in AK
Legal business name
MAKING A DIFFERENCE SUPPORT SERVICES
Practice address
1867 Airport Way
Suite 200
Fairbanks, AK 99701-4054
Phone
(907) 750-7169
Fax
(907) 490-4469
NPI assigned
Apr 18, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2016

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

Authorized official

Name
Crystal McCormick, LCSWNPI 1790029114
Title
Owner
Phone
(907) 750-7169

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 1053 AK Primary

Addresses

Primary practice location

1867 Airport Way
Suite 200
Fairbanks, AK 99701-4054

Mailing address

1302 Benshoof Dr
North Pole, AK 99705-5666
Phone (907) 590-2100

Other identifiers 2

IdentifierTypeStateIssuer
1634221MedicaidAK
K164905OtherAKMEDICARE PTAN

National Provider Directory

National Provider Directory

Locations

1867 Airport Way
Ste 200
Fairbanks, AK 99701
Phone (907) 590-2100

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460937600000",
    "number": "1558715391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 BENSHOOF DR",
            "city": "NORTH POLE",
            "state": "AK",
            "postal_code": "997055666",
            "telephone_number": "907-590-2100",
            "fax_number": "907-490-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1867 AIRPORT WAY",
            "address_2": "SUITE 200",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014054",
            "telephone_number": "907-750-7169",
            "fax_number": "907-490-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAKING A DIFFERENCE SUPPORT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-18",
        "last_updated": "2016-04-18",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-750-7169",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "AK",
            "license": "1053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1634221",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "K164905",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.