Individual provider Active NPI

Marisa Smith, LCSW

  • Clinical Social Worker
  • Indianapolis, IN
National Provider Identifier
1649633702
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34007351A Issued in IN
Practice address
5908 E Stop 11 Rd
Indianapolis, IN 46237-8683
Phone
(317) 497-6800
NPI assigned
Apr 5, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

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 34007351A IN Primary

Addresses

Primary practice location

5908 E Stop 11 Rd
Indianapolis, IN 46237-8683

Mailing address

6626 E 75TH St
Ste 500
Indianapolis, IN 46250-2805

Other practice location 1

5545 E Stop 11 Rd
Indianapolis, IN 46237-8616
Phone (317) 497-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20160520001425 IN Practitioner - Clinical Social Worker 2961791538 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians

Practice addresses (Care Compare)

5545 E Stop 11 Rd
Indianapolis, IN 46237-8616
Phone (317) 884-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34007351AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc CurrentSince Dec 15, 2016 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Dec 15, 2016 Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

5545 E Stop 11 Rd
Indianapolis, IN 46237
Phone (317) 497-6800

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

2040 N Shadeland Ave
Ste 300
Indianapolis, IN 46219
Phone (317) 355-3232

5908 E Stop 11 Rd
Indianapolis, IN 46237
Phone (317) 497-6800

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

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": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539734400000",
    "number": "1649633702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST",
            "address_2": "STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5908 E STOP 11 RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378683",
            "telephone_number": "317-497-6800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5545 E Stop 11 Rd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462378616",
            "country_code": "US",
            "telephone_number": "317-497-6800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARISA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-05",
        "last_updated": "2018-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007351A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.