Active NPI
Charrisse Leiana Wilson, LCSW
- Clinical Social Worker
- Bloomsburg, PA
National Provider Identifier
1639853013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 211 E 1St St
Bloomsburg, PA 17815-1405 - Phone
- (718) 506-1115
- NPI assigned
- Jun 14, 2023
- 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
211 E 1St St
Bloomsburg, PA 17815-1405
Mailing address
27 Randolph Rd
Howell, NJ 07731-8611
Phone (718) 506-1115
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2109 Red Lion Rd
Philadelphia, PA 19115-1711
Phone (718) 298-4375
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.8 of 100
- Quality
- 76.62
- Improvement activities
- 40
- Cost
- 78.87
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supportive Care of Pennsylvania LLC | Current | Accepting new patients |
Locations
27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951
2109 Red Lion Rd
Philadelphia, PA 19115
Phone (215) 213-7000
Organizations & group practices 1
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": "1686700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686700800000",
"number": "1639853013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27 RANDOLPH RD",
"city": "HOWELL",
"state": "NJ",
"postal_code": "077318611",
"telephone_number": "718-506-1115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 E 1ST ST",
"city": "BLOOMSBURG",
"state": "PA",
"postal_code": "178151405",
"telephone_number": "718-506-1115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CHARRISSE",
"middle_name": "LEIANA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-14",
"last_updated": "2023-06-14",
"certification_date": "2023-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomsburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; 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.