Individual provider Active NPI

Amelia Louise Shah, BSW

  • Clinical Social Worker
  • Renton, WA
National Provider Identifier
1750655577
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW61100371 Issued in WA
Practice address
4445 Talbot Rd S
Renton, WA 98055-6219
Phone
(425) 690-3414
Fax
(425) 690-9414
NPI assigned
Feb 24, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 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 LW61100371 WA
Clinical Social Worker 1041C0700X LW61100371 WA Primary

Addresses

Primary practice location

4445 Talbot Rd S
Renton, WA 98055-6219

Mailing address

4445 Talbot Rd S
Renton, WA 98055-6219
Phone (425) 690-3414

Other practice location 1

3322 Broadway
Everett, WA 98201-4425
Phone (425) 349-6800

Other identifiers 1

IdentifierTypeStateIssuer
210012MedicaidWA

Other names 1

  • Amelia Kent Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20210412002475 WA Practitioner - Clinical Social Worker 1951719970 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Medical Group-Renton CurrentSince Apr 1, 2021 Accepting new patients

Locations

16850 SE 272nd St
Ste 100
Covington, WA 98042
Phone (253) 395-1971

4445 Talbot Rd S
Renton, WA 98055
Phone (425) 656-4055

3600 Lind Ave SW
Ste 100
Renton, WA 98057

Organizations & group practices 1

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": "1330041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1750655577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 TALBOT RD S",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556219",
            "telephone_number": "425-690-3414",
            "fax_number": "425-690-9414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 TALBOT RD S",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556219",
            "telephone_number": "425-690-3414",
            "fax_number": "425-690-9414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3322 Broadway",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982014425",
            "country_code": "US",
            "telephone_number": "425-349-6800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "AMELIA",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "BSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-24",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "LW61100371",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61100371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210012",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMELIA",
            "last_name": "KENT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Renton, WA

Sources for this page

Verify at the official NPI Registry.