Active NPI
Martin Model, MSW
- Clinical Social Worker
- Durango, CO
National Provider Identifier
1780095414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 983015
- Practice address
- 1200 Florida Rd Apt 23
Durango, CO 81301-4486 - Phone
- (970) 563-4581
- Fax
- (970) 563-0208
- NPI assigned
- May 15, 2014
- 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 | 983015 | CO | Primary |
Addresses
Primary practice location
1200 Florida Rd Apt 23
Durango, CO 81301-4486
Mailing address
1200 Florida Rd Apt 23
Durango, CO 81301-4486
Phone (970) 563-4581
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07983018 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 983015 | CO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400112000000",
"number": "1780095414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 FLORIDA RD APT 23",
"city": "DURANGO",
"state": "CO",
"postal_code": "813014486",
"telephone_number": "970-563-4581",
"fax_number": "970-563-0208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 FLORIDA RD APT 23",
"city": "DURANGO",
"state": "CO",
"postal_code": "813014486",
"telephone_number": "970-563-4581",
"fax_number": "970-563-0208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODEL",
"first_name": "MARTIN",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-15",
"last_updated": "2014-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CO",
"license": "983015",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "07983018",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Durango, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.