Active NPI
Mitra S Pedram, MSW, LCSW
- Clinical Social Worker
- Springfield, MO
National Provider Identifier
1649801358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2022007696
- Practice address
- 1300 E Bradford Pkwy
Springfield, MO 65804-4264 - Phone
- (417) 761-5000
- NPI assigned
- Jan 31, 2020
- Sex
- Female
- Sole proprietor
- No
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 | 2022007696 | MO | Primary |
Addresses
Primary practice location
1300 E Bradford Pkwy
Springfield, MO 65804-4264
Mailing address
1300 E Bradford Pkwy
Springfield, MO 65804-4264
Phone (417) 761-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022007696 | MO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1766966400000",
"number": "1649801358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 E BRADFORD PKWY",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658044264",
"telephone_number": "417-761-5000",
"fax_number": "417-761-5065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 E BRADFORD PKWY",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658044264",
"telephone_number": "417-761-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDRAM",
"first_name": "MITRA",
"middle_name": "S",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-31",
"last_updated": "2025-12-29",
"certification_date": "2025-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "2022007696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.