Individual provider Active NPI

Mary T Hughes-Paulline, LISW

  • Clinical Social Worker
  • Davenport, IA
National Provider Identifier
1689649063
Registry record updated Apr 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
00097 Issued in IA
Practice address
2102 E 38TH St
Psychology Health Group
Davenport, IA 52807-1135
Phone
(563) 354-4049
Fax
(563) 359-4069
NPI assigned
Feb 21, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2013

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 00097 IA Primary

Addresses

Primary practice location

2102 E 38TH St
Psychology Health Group
Davenport, IA 52807-1135

Mailing address

2102 E 38TH St
Psychology Health Group
Davenport, IA 52807-1135
Phone (563) 354-4049

Other identifiers 1

IdentifierTypeStateIssuer
1108750000MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20041022000066 IA Practitioner - Clinical Social Worker 0143281261 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Des Moines Pastoral Counseling CenterGroup PAC ID 0749272649, 22 clinicians

Practice addresses (Care Compare)

8553 Urbandale Ave
Urbandale, IA 50322-4108
Phone (515) 274-4006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
97IAMDCounseling Psychologist
00097IAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mind and Spirit Counseling Center CurrentSince Jan 6, 2020 Accepting new patients

Locations

8553 Urbandale Ave
Urbandale, IA 50322
Phone (515) 274-4006

Organizations & group practices 2

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366848000000",
    "number": "1689649063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2102 E 38TH ST",
            "address_2": "PSYCHOLOGY HEALTH GROUP",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528071135",
            "telephone_number": "563-354-4049",
            "fax_number": "563-359-4069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 E 38TH ST",
            "address_2": "PSYCHOLOGY HEALTH GROUP",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528071135",
            "telephone_number": "563-354-4049",
            "fax_number": "563-359-4069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUGHES-PAULLINE",
        "first_name": "MARY",
        "middle_name": "T",
        "name_prefix": "Mrs.",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2013-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "00097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1108750000",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.