Individual provider Active NPI

Stephanie Lynn Medeiros

  • Clinical Social Worker
  • Taunton, MA
National Provider Identifier
1619555109
Registry record updated May 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
126535 Issued in MA
Practice address
1 Washington St
Taunton, MA 02780-5293
Phone
(508) 324-5408
NPI assigned
Mar 29, 2021
Last updated
May 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2023

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 226452 MA
Clinical Social Worker 1041C0700X 126535 MA Primary

Addresses

Primary practice location

1 Washington St
Taunton, MA 02780-5293

Mailing address

5 Stanton CT
New Bedford, MA 02740-4760
Phone (508) 324-5408

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20231207004104 MA Practitioner - Clinical Social Worker 2668821299 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

363 Highland Ave
Fall River, MA 02720-3703
Phone (508) 973-5919

874 Purchase St
New Bedford, MA 02740-6232
Phone (508) 992-6553

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
226452MAMDSocial Worker
126535MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Greater New Bedford Community Health Center, Inc. CurrentSince Jun 8, 2024 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Oct 30, 2023 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Oct 30, 2023 Accepting new patients
Greater New Bedford Community Health Center, Inc. CurrentSince Jun 8, 2024 Accepting new patients

Locations

200 Mill Rd
Ste 180
Fairhaven, MA 02719
Phone (508) 973-2000

363 Highland Ave
Fall River, MA 02720
Phone (508) 679-7052

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

101 Page St
New Bedford, MA 02740
Phone (508) 961-5425

874 Purchase St
New Bedford, MA 02740
Phone (508) 992-6553

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1619555109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 STANTON CT",
            "city": "NEW BEDFORD",
            "state": "MA",
            "postal_code": "027404760",
            "telephone_number": "508-324-5408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WASHINGTON ST",
            "city": "TAUNTON",
            "state": "MA",
            "postal_code": "027805293",
            "telephone_number": "508-324-5408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDEIROS",
        "first_name": "STEPHANIE",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-29",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "226452",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "126535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Taunton, MA

Sources for this page

Verify at the official NPI Registry.