Individual provider Active NPI

Susanne Walker Graham, LCSW, MSW

  • Clinical Social Worker
  • Goshen, IN
National Provider Identifier
1669642229
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW18176 Issued in FL
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

Updated by the provider on Mar 30, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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 Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210503002723 FL Practitioner - Clinical Social Worker 8729271481 Reassigns benefits to 1 organization

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
University of Florida Jacksonville Physicians, Inc.Group PAC ID 9133025869, 908 clinicians

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

LicenseStateTypeSpecialty
SW18176FLMDClinical Social Worker
34005937AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians, Inc. CurrentSince May 10, 2021 Accepting new patients
University of Florida Jacksonville Physicians Inc Current Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince May 10, 2021 Accepting new patients
Psych Pointe LLC PastSince Jan 7, 2024 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

  • FHIR API: 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.

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

Verify at the official NPI Registry.