Individual provider Active NPI

Susan Gallen, LCSW

  • Clinical Social Worker
  • Fort Myers, FL
National Provider Identifier
1720638570
Registry record updated Sep 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW7308 Issued in FL
Practice address
4310 Metro Pkwy Ste 205
Fort Myers, FL 33916-9416
Phone
(239) 223-2751
NPI assigned
Sep 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2019

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 SW7308 FL Primary

Addresses

Primary practice location

4310 Metro Pkwy Ste 205
Fort Myers, FL 33916-9416

Mailing address

4310 Metro Pkwy Ste 205
Fort Myers, FL 33916-9416
Phone (239) 223-2751

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20191009001402 FL Practitioner - Clinical Social Worker 9133176555 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dna Comprehensive Therapy Services LLCGroup PAC ID 2860619632, 446 clinicians

Practice addresses (Care Compare)

4310 Metro Pkwy
Suite 205
Fort Myers, FL 33916-9416
Phone (239) 223-2751

Merit-based Incentive Payment System (MIPS)

Final score
87.43 of 100Reported as group
Quality
74.02
Promoting interoperability
100
Improvement activities
40
Cost
77.26

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dna Comprehensive Therapy Services, LLC Clinical CurrentSince Sep 30, 2019 Accepting new patients
Bonita Springs Retirement Village, Inc. CurrentSince Sep 30, 2019 Accepting new patients

Locations

4310 Metro Pkwy
Ste 205
Fort Myers, FL 33916

Interoperability endpoints

  • Direct secure messaging: susan.gallen.1@13142.direct.athenahealth.com

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": "1568332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568332800000",
    "number": "1720638570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 METRO PKWY STE 205",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339169416",
            "telephone_number": "239-223-2751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 METRO PKWY STE 205",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339169416",
            "telephone_number": "239-223-2751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLEN",
        "first_name": "SUSAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-13",
        "last_updated": "2019-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW7308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.