Individual provider Active NPI

Mia Concordia, MSW, LICSW

  • Clinical Social Worker
  • Burien, WA
National Provider Identifier
1609242890
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW61076495 Issued in WA
Practice address
16045 1St Ave S FL 1
Burien, WA 98148-1401
Phone
(206) 965-4100
Fax
(206) 965-4119
NPI assigned
Aug 11, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X LW61076495 WA
Clinical Social Worker 1041C0700X LW61076495 WA Primary

Addresses

Primary practice location

16045 1St Ave S FL 1
Burien, WA 98148-1401

Mailing address

16045 1St Ave S
FL 1
Burien, WA 98148-1401
Phone (206) 965-4100

Other identifiers 1

IdentifierTypeStateIssuer
2165261MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20201015001600 WA Practitioner - Clinical Social Worker 4183044035 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

16045 1St Ave S
FL 1
Burien, WA 98148-1401
Phone (206) 965-4124

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group Current Accepting new patients
Franciscan Medical Group CurrentSince Sep 28, 2020 Accepting new patients

Locations

16045 1st Ave S
Fl 1
Burien, WA 98148
Phone (206) 965-4100

34503 9th Ave S
Ste 130
Federal Way, WA 98003
Phone (253) 835-5340

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": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1609242890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16045 1ST AVE S",
            "address_2": "FL 1",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981481401",
            "telephone_number": "206-965-4100",
            "fax_number": "206-965-4119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16045 1ST AVE S FL 1",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981481401",
            "telephone_number": "206-965-4100",
            "fax_number": "206-965-4119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONCORDIA",
        "first_name": "MIA",
        "name_prefix": "Ms.",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "LW61076495",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61076495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2165261",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burien, WA

Sources for this page

Verify at the official NPI Registry.