Individual provider Active NPI

Maci Wageman, CSWA

  • Clinical Social Worker
  • Grants Pass, OR
National Provider Identifier
1801347612
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L10399 Issued in OR
Practice address
1545 Harbeck Rd
Grants Pass, OR 97527-5605
Phone
(541) 476-2373
NPI assigned
Oct 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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 L10399 OR Primary

Addresses

Primary practice location

1545 Harbeck Rd
Grants Pass, OR 97527-5605

Mailing address

1215 SW G St
Grants Pass, OR 97526-2544
Phone (541) 476-2373

Other identifiers 1

IdentifierTypeStateIssuer
7565AOtherOUTPATIENT MENTAL HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20210412001669 OR Practitioner - Clinical Social Worker 5597173591 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Options for Southern OregonGroup PAC ID 0941202006, 70 clinicians

Practice addresses (Care Compare)

320 SW Ramsey Ave
Grants Pass, OR 97527-5529
Phone (541) 476-2373

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L10399ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Options for Southern Oregon CurrentSince Dec 23, 2020 Accepting new patients
Options for Southern Oregon CurrentSince Feb 18, 2024 Accepting new patients
Options for Southern Oregon Past Accepting new patients

Locations

320 SW Ramsey Ave
Grants Pass, OR 97527
Phone (541) 472-9967

1545 Harbeck Rd
Grants Pass, OR 97527
Phone (541) 479-2371

1215 SW G St
Grants Pass, OR 97526
Phone (541) 244-4109

Organizations & group practices 3

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": "1476662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1801347612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 SW G ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975262544",
            "telephone_number": "541-476-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 HARBECK RD",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275605",
            "telephone_number": "541-476-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGEMAN",
        "first_name": "MACI",
        "name_prefix": "Mrs.",
        "credential": "CSWA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-17",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L10399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OUTPATIENT MENTAL HEALTH",
            "identifier": "7565A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

Verify at the official NPI Registry.