Individual provider Active NPI

Karen E. Macdonald, LCSW

  • Clinical Social Worker
  • Charlestown, RI
National Provider Identifier
1700948080
Registry record updated Apr 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW00265 Issued in RI
Practice address
4705 Old Post Rd Unit a
Charlestown, RI 02813-1842
Phone
(401) 364-7705
Fax
(401) 364-3310
NPI assigned
Dec 14, 2006
Last updated
Apr 22, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2016

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 CSW00265 RI Primary

Addresses

Primary practice location

4705 Old Post Rd Unit a
Charlestown, RI 02813-1842

Mailing address

PO Box 899
Charlestown, RI 02813-0899
Phone (401) 364-7705

Other identifiers 3

IdentifierTypeStateIssuer
003401501OtherRIMEDICARE PTAN
1700948080OtherRIBLUE CROSS BLUE SHIELD
KM33742-1700940080MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20130913000360 RI Practitioner - Clinical Social Worker 6103060157 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gateway Healthcare IncGroup PAC ID 7719874908, 66 clinicians

Practice addresses (Care Compare)

1516 Atwood Ave
Johnston, RI 02919-3223
Phone (401) 553-1000

4705 Old Post Rd
Charlestown, RI 02813-1842

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CSW00265RIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Gateway Healthcare Inc CurrentSince Jul 1, 2013 Accepting new patients
South Shore Center Inc Clinical Past Accepting new patients

Locations

1516 Atwood Ave
Johnston, RI 02919
Phone (401) 463-8829

1 Virginia Ave
Ste 200
Providence, RI 02905

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

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, 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": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461283200000",
    "number": "1700948080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 899",
            "city": "CHARLESTOWN",
            "state": "RI",
            "postal_code": "028130899",
            "telephone_number": "401-364-7705",
            "fax_number": "401-364-3310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 OLD POST RD UNIT A",
            "city": "CHARLESTOWN",
            "state": "RI",
            "postal_code": "028131842",
            "telephone_number": "401-364-7705",
            "fax_number": "401-364-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACDONALD",
        "first_name": "KAREN",
        "middle_name": "E.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-14",
        "last_updated": "2016-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "CSW00265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "003401501",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1700948080",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "KM33742-1700940080",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlestown, RI

Sources for this page

Verify at the official NPI Registry.