NPIMap

Individual provider Active NPI

Kathleen Peters, MSW

  • Clinical Social Worker
  • Roseburg, OR
National Provider Identifier
1831240324
Registry record updated Oct 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L7293 Issued in OR
Practice address
621 W Madrone St
Roseburg, OR 97470-3090
Phone
(541) 672-2691
NPI assigned
Jan 13, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801085075 MI
Clinical Social Worker 1041C0700X L7293 OR Primary

Addresses

Primary practice location

621 W Madrone St
Roseburg, OR 97470-3090

Mailing address

PO Box 1121
Roseburg, OR 97470-0254

Other practice location 1

400 Johnson St
Alpena, MI 49707-1434
Phone (989) 356-2161 ext. 7716

Other identifiers 1

IdentifierTypeStateIssuer
680108075OtherMIMICHIGAN STATE LICENSE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191015002339 OR Practitioner - Clinical Social Worker 6709970213 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
AdaptGroup PAC ID 4587662887, 43 clinicians

Practice addresses (Care Compare)

621 W Madrone St
Roseburg, OR 97470-3090
Phone (541) 492-4550

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Adapt CurrentSince Aug 12, 2019 Accepting new patients
Adapt Current Accepting new patients
Adapt CurrentSince Aug 12, 2019 Accepting new patients
Northeast Michigan Community Mental Health Authority PastSince Jul 20, 2005 Accepting new patients
Northeast Michigan Community Mental Health Authority Past Accepting new patients

Locations

621 W Madrone St
Roseburg, OR 97470
Phone (541) 440-3571

548 SE Jackson St
Roseburg, OR 97470
Phone (541) 492-0241

Organizations & group practices 10

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": "1168646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571097600000",
    "number": "1831240324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1121",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974700254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 W MADRONE ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703090",
            "telephone_number": "541-672-2691"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Johnson St",
            "address_purpose": "LOCATION",
            "city": "Alpena",
            "state": "MI",
            "postal_code": "497071434",
            "country_code": "US",
            "telephone_number": "989-356-2161 x7716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERS",
        "first_name": "KATHLEEN",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-13",
        "last_updated": "2019-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801085075",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L7293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHIGAN STATE LICENSE #",
            "identifier": "680108075",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.