Individual provider Active NPI

Timothy Hugh Scannell

  • Clinical Social Worker
  • Rio Rancho, NM
National Provider Identifier
1669087417
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
X-11654 Issued in NM
Practice address
500 Unser Blvd SE Ste 103
Rio Rancho, NM 87124-4660
Phone
(505) 404-0554
NPI assigned
Sep 9, 2020
Last updated
Sep 9, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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 X-11654 NM Primary

Addresses

Primary practice location

500 Unser Blvd SE Ste 103
Rio Rancho, NM 87124-4660

Mailing address

9805 San Gabriel Rd NE
Albuquerque, NM 87111-3530
Phone (505) 280-5753

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
X-11654NMMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
A Childs Voice CurrentSince Mar 9, 2021 Accepting new patients

Locations

500 Unser Blvd SE
Ste 103
Rio Rancho, NM 87124
Phone (505) 404-0554

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1669087417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9805 SAN GABRIEL RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113530",
            "telephone_number": "505-280-5753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 UNSER BLVD SE STE 103",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871244660",
            "telephone_number": "505-404-0554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCANNELL",
        "first_name": "TIMOTHY",
        "middle_name": "HUGH",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-09",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "X-11654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rio Rancho, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.