Active NPI
Martin Van Dyke Pool, LCSW
- Clinical Social Worker
- Cartersville, VA
National Provider Identifier
1710990338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904008797
- Practice address
- 83 Boston Hill Rd
Cartersville, VA 23027-9716 - Phone
- (434) 409-2596
- NPI assigned
- Aug 14, 2006
- Last updated
- Apr 24, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904008797 | VA | Primary |
Addresses
Primary practice location
83 Boston Hill Rd
Cartersville, VA 23027-9716
Mailing address
83 Boston Hill Rd
Cartersville, VA 23027-9716
Phone (434) 409-2596
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161221001477 | VA | Practitioner - Clinical Social Worker | 4688955123 | Practice locations: North Chesterfield, VA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
555 Southlake Blvd
Suite 3
North Chesterfield, VA 23236-3060
Phone (434) 409-2596
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0904008797 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429833600000",
"number": "1710990338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "83 BOSTON HILL RD",
"city": "CARTERSVILLE",
"state": "VA",
"postal_code": "230279716",
"telephone_number": "434-409-2596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "83 BOSTON HILL RD",
"city": "CARTERSVILLE",
"state": "VA",
"postal_code": "230279716",
"telephone_number": "434-409-2596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POOL",
"first_name": "MARTIN",
"middle_name": "VAN DYKE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2015-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904008797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cartersville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; 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.