Colleen Wetherwax, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I2002109 Issued in OH

Practice address

13300 Aquilla Rd
Chardon, OH 44024-7944

Phone

(440) 279-2090

Fax

(440) 285-2574

NPI assigned

May 31, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Colleen Bednar Former name

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Clinical Social Worker

Education

Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ravenwood Mental Health CenterGroup PAC ID 6901813922, 57 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.68 of 100Reported as group

Quality

90.83

Improvement activities

40

Cost

72.41

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/ravenwoodhealth/r4/

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.

• Ravenwood Mental Health Center

  • Community/Behavioral Health Agency
  • Chardon, OH
  • NPI 1730356296
  Medicare reassignment Care Compare group NPD
• Ravenwood Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chardon, OH
  • NPI 1053345975
  NPD
• Ravenwood Mental Health Center

  • Addiction (Substance Use Disorder) Counselor
  • Chardon, OH
  • NPI 1912265794
  NPD

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590105600000",
    "number": "1669820734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12557 RAVENWOOD DR",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440249009",
            "telephone_number": "440-285-3568",
            "fax_number": "440-285-2207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13300 AQUILLA RD",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440247944",
            "telephone_number": "440-279-2090",
            "fax_number": "440-285-2574"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12557 Ravenwood Dr",
            "address_purpose": "LOCATION",
            "city": "Chardon",
            "state": "OH",
            "postal_code": "440249009",
            "country_code": "US",
            "telephone_number": "440-285-3568",
            "fax_number": "440-285-4552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "695 South St",
            "address_purpose": "LOCATION",
            "city": "Chardon",
            "state": "OH",
            "postal_code": "440241474",
            "country_code": "US",
            "telephone_number": "440-285-1631",
            "fax_number": "440-285-1634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WETHERWAX",
        "first_name": "COLLEEN",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-31",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I2002109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0265005",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "BEDNAR",
            "credential": "LSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sherri Welton
• Jamie Wenger
• Margie Wenz, MD
• Ruby J Westbrook
• Western Reserve Speech&Language Partners
• Judith Whelan
• Jakob E White, DPM
• Katelynn White
• Roshaunda White
• Morgan Whitely, M.ED., LPCC-S

• Clinical Social Worker in Chardon, OH
• Providers in Chardon, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2020; 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.

Verify at the official NPI Registry.