Active NPI
Mimi Elizabeth Crawley
- Clinical Social Worker
- Wilmington, NC
National Provider Identifier
1639601594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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, NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
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 Carolina
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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifesource of North Carolina | Clinical | Current | Accepting new patients |
| Lifesource of North Carolina | Clinical | Current | Accepting new patients |
| Lifesource of North Carolina | Clinical | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.