Individual provider Active NPI

Amanda M Carlson

  • Clinical Social Worker
  • Siloam Springs, AR
National Provider Identifier
1689190613
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
710 S Holly St
Siloam Springs, AR 72761-3304
Phone
(479) 248-6185
NPI assigned
Aug 22, 2017
Last updated
Jan 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

710 S Holly St
Siloam Springs, AR 72761-3304

Mailing address

2400 S 48TH St
Springdale, AR 72762-6683
Phone (479) 750-2020

Other names 1

  • Amanda M Douglas Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: No
  • 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
I20230605003395 AR Practitioner - Clinical Social Worker 8123485224 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Arisa Health, Inc. CurrentSince Aug 1, 2023 Accepting new patients
Arisa Health, Inc. Social Worker Current Accepting new patients
Ozark Guidance Center, Inc Social Worker CurrentSince Feb 21, 2023 Accepting new patients
Ozark Guidance Center, Inc CurrentSince Feb 21, 2023 Accepting new patients

Locations

2003 SE Walton Blvd
Bentonville, AR 72712
Phone (479) 464-5925

1104 N College St
Huntsville, AR 72740
Phone (479) 738-2878

2707 Browns Ln
Jonesboro, AR 72401
Phone (870) 972-4000

710 S Holly St
Siloam Springs, AR 72761
Phone (479) 524-8618

827 W Harvard St
Siloam Springs, AR 72761
Phone (479) 549-3109

2400 S 48th St
Springdale, AR 72762
Phone (479) 725-5115

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, 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": "1503360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673568000000",
    "number": "1689190613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 S 48TH ST",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727626683",
            "telephone_number": "479-750-2020",
            "fax_number": "479-750-4843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S HOLLY ST",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "727613304",
            "telephone_number": "479-248-6185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "AMANDA",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-22",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "DOUGLAS",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Siloam Springs, AR

Sources for this page

Verify at the official NPI Registry.