Individual provider Active NPI

Mimi Elizabeth Crawley

  • Clinical Social Worker
  • Wilmington, NC
National Provider Identifier
1639601594
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
3205 Randall Pkwy Ste 105
Wilmington, NC 28403-2565
Phone
(910) 742-9243
Fax
(888) 746-1787
NPI assigned
Mar 30, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

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 Primary

Addresses

Primary practice location

3205 Randall Pkwy Ste 105
Wilmington, NC 28403-2565

Mailing address

PO Box 538622
Atlanta, GA 30353-8622

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170810002895 SC Practitioner - Clinical Social Worker 9234409152 Reassigns benefits to 1 organization
I20171114000209 NC Practitioner - Clinical Social Worker 9234409152 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of South Carolina School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifesource of North CarolinaGroup PAC ID 7416132428, shared by 9 NPIs, 172 clinicians

Practice addresses (Care Compare)

3205 Randall Pkwy
Suite 105
Wilmington, NC 28403-2565
Phone (910) 742-9243

939 Springdale Dr
Clinton, SC 29325-7266
Phone (910) 742-9243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesource of North Carolina Clinical CurrentSince Apr 17, 2017 Accepting new patients
Lifesource of North Carolina Clinical CurrentSince Aug 19, 2017 Accepting new patients
Lifesource of North Carolina Clinical CurrentSince Apr 17, 2017 Accepting new patients

Locations

3205 Randall Pkwy
Ste 105
Wilmington, NC 28403
Phone (910) 338-2880

1915 Ebenezer Rd
Rock Hill, SC 29732
Phone (305) 866-9951

Organizations & group practices 3

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": "1490832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490832000000",
    "number": "1639601594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 538622",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303538622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3205 RANDALL PKWY STE 105",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284032565",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAWLEY",
        "first_name": "MIMI",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-30",
        "last_updated": "2017-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.