Individual provider Active NPI

Ronda Lynn Wilson-Carr, LCSW

  • Clinical Social Worker
  • Merrillville, IN
National Provider Identifier
1770615387
Registry record updated Apr 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34005583 Issued in IN
Practice address
6091 Broadway
Merrillville, IN 46410-2619
Phone
(219) 763-8112
Fax
(219) 764-3251
NPI assigned
Mar 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2015

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 34005583 IN Primary

Addresses

Primary practice location

6091 Broadway
Merrillville, IN 46410-2619

Mailing address

PO Box 1430
Portage, IN 46368-9230
Phone (219) 763-8112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20081027000778 IN Practitioner - Clinical Social Worker 8820156359 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southlake Community Mental Health Center, Inc. CurrentSince Mar 1, 2021 Accepting new patients

Locations

8555 Taft St
Merrillville, IN 46410
Phone (219) 736-7232

8400 Louisiana St
Merrillville, IN 46410
Phone (219) 757-1924

Interoperability endpoints

  • Direct secure messaging: ronda.carr.p1@direct.northshorehealth.nextgenshare.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": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428451200000",
    "number": "1770615387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1430",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463689230",
            "telephone_number": "219-763-8112",
            "fax_number": "219-764-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6091 BROADWAY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464102619",
            "telephone_number": "219-763-8112",
            "fax_number": "219-764-3251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON-CARR",
        "first_name": "RONDA",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2015-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

Verify at the official NPI Registry.