Individual provider Active NPI

Emily Matthews

  • Social Worker
  • Milwaukee, WI
National Provider Identifier
1790193365
Registry record updated Sep 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
128853 Issued in WI
Practice address
11414 W Park PL
Suite 202
Milwaukee, WI 53224-3500
Phone
(414) 292-7060
Fax
(414) 973-2090
NPI assigned
Jul 28, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 128853 WI Primary

Addresses

Primary practice location

11414 W Park PL
Suite 202
Milwaukee, WI 53224-3500

Mailing address

11414 W Park PL
Suite 202
Milwaukee, WI 53224-3500
Phone (414) 292-7060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20160919002689 WI Practitioner - Clinical Social Worker 5395032312 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
128853WIMDSocial Worker
8275WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Abg Wellness Group Inc CurrentSince Aug 8, 2016 Accepting new patients

Locations

11414 W Park Pl
Ste 202
Milwaukee, WI 53224
Phone (414) 292-7060

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": "1406505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473120000000",
    "number": "1790193365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11414 W PARK PL",
            "address_2": "SUITE 202",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532243500",
            "telephone_number": "414-292-7060",
            "fax_number": "414-973-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11414 W PARK PL",
            "address_2": "SUITE 202",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532243500",
            "telephone_number": "414-292-7060",
            "fax_number": "414-973-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHEWS",
        "first_name": "EMILY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-28",
        "last_updated": "2016-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "128853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.