Individual provider Active NPI

Alicia Lynn Graham, LISW-S

  • Clinical Social Worker
  • Archbold, OH
National Provider Identifier
1790976744
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.0800184-SUPV Issued in OH
Practice address
22251 State Route 2
Archbold, OH 43502-9452
Phone
(419) 445-1552
Fax
(419) 445-1401
NPI assigned
Aug 6, 2007
Last updated
Nov 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X S.0500348 OH
Social Worker 104100000X I.0800184 OH
Clinical Social Worker 1041C0700X I.0800184-SUPV OH Primary

Addresses

Primary practice location

22251 State Route 2
Archbold, OH 43502-9452

Mailing address

17420 County Road 17F
Bryan, OH 43506-9446
Phone (419) 310-9524

Other identifiers 2

IdentifierTypeStateIssuer
1790976744MedicaidOH
0166914MedicaidOH

Other names 1

  • Mrs. Alicia Lynn Buehrer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20140523000596 OH Practitioner - Clinical Social Worker 9335287713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shalom MinistriesGroup PAC ID 7911376033, 7 clinicians

Practice addresses (Care Compare)

22251 State Route 2
Archbold, OH 43502-9452
Phone (419) 445-1552

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S.0500348OHMDMental Health Counselor
I.0800184OHMDSocial Worker
I.0800184-SUPVOHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Shalom Ministries CurrentSince Nov 23, 2024 Accepting new patients

Locations

22251 State Route 2
Archbold, OH 43502
Phone (419) 445-1552

5030 County Road 15
#C
Bryan, OH 43506
Phone (419) 636-1713

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1790976744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17420 COUNTY ROAD 17F",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435069446",
            "telephone_number": "419-310-9524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22251 STATE ROUTE 2",
            "city": "ARCHBOLD",
            "state": "OH",
            "postal_code": "435029452",
            "telephone_number": "419-445-1552",
            "fax_number": "419-445-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "ALICIA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-06",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "S.0500348",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I.0800184",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.0800184-SUPV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790976744",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0166914",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICIA",
            "last_name": "BUEHRER",
            "middle_name": "LYNN",
            "prefix": "MRS.",
            "credential": "LISW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Archbold, OH

Sources for this page

Verify at the official NPI Registry.