Active NPI
Susanne Walker Graham, LCSW, MSW
- Clinical Social Worker
- Goshen, IN
National Provider Identifier
1669642229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW18176
- Practice address
- 808 N 3Rd St
Goshen, IN 46528 - Phone
- (574) 534-0088
- Fax
- (574) 971-8434
- NPI assigned
- Mar 10, 2008
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 34005937A | IN | |
| Counselor | 101Y00000X | |||
| Clinical Social Worker | 1041C0700X | SW18176 | FL | Primary |
Addresses
Primary practice location
808 N 3Rd St
Goshen, IN 46528
Mailing address
808 N 3Rd St
Goshen, IN 46528-7100
Phone (574) 534-0088
Other practice location 1
213 Middlebury St
Goshen, IN 46528-2956
Phone (574) 534-3300
Other names 1
- Susanne E Walker
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | swalkergraham299504@direct.ochin.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- 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
- University of Michigan Medical School, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
8274 Bayberry Rd
Jacksonville, FL 32256-7470
Phone (904) 633-0800
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW18176 | FL | MD | Clinical Social Worker |
| 34005937A | IN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Florida Jacksonville Physicians, Inc. | Current | Accepting new patients | |
| University of Florida Jacksonville Physicians Inc | Current | Accepting new patients | |
| University of Florida Jacksonville Physicians, Inc. | Current | Accepting new patients | |
| Psych Pointe LLC | Past | Accepting new patients |
Locations
655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680
8274 Bayberry Rd
Jacksonville, FL 32256
Phone (904) 633-0800
Interoperability endpoints
- https://api.platform.athenahealth.com/24035/brand/1/csg/1/fhir/r4
Organizations & group practices 4
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.
-
- Diagnostic Radiology Physician
- Jacksonville, FL
- NPI 1326208695
-
- Family Medicine Physician
- Jacksonville, FL
- NPI 1235398983
-
- Physiological Laboratory
- Jacksonville, FL
- NPI 1831800952
-
- Community/Behavioral Health Agency
- Mishawaka, IN
- NPI 1861087355
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617062400000",
"number": "1669642229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "808 N 3RD ST",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465287100",
"telephone_number": "574-534-0088",
"fax_number": "574-971-8434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "808 N 3RD ST",
"city": "GOSHEN",
"state": "IN",
"postal_code": "46528",
"telephone_number": "574-534-0088",
"fax_number": "574-971-8434"
}
],
"practiceLocations": [
{
"address_1": "213 Middlebury St",
"address_purpose": "LOCATION",
"city": "Goshen",
"state": "IN",
"postal_code": "465282956",
"country_code": "US",
"telephone_number": "574-534-3300",
"fax_number": "574-534-5412",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRAHAM",
"first_name": "SUSANNE",
"middle_name": "WALKER",
"credential": "LCSW, MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-10",
"last_updated": "2021-03-30",
"certification_date": "2021-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34005937A",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW18176",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "swalkergraham299504@direct.ochin.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "808 N 3rd St",
"city": "Goshen",
"state": "IN",
"country_code": "US",
"postal_code": "46528",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "SUSANNE",
"last_name": "WALKER",
"middle_name": "E",
"credential": "MSW",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.