Christine A Ferguson, LICDC-LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2102896 Issued in OH

Practice address

16360 Broadway Ave Ste B101
Maple Heights, OH 44137-2573

Phone

(216) 510-7170

Fax

(216) 510-7213

NPI assigned

Jan 12, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Christine Adaline Ferguson LSW, Licdc LLC

  • Community/Behavioral Health Agency
  • Maple Heights, OH
  • NPI 1326674052
  Medicare reassignment NPD Authorized official
• Christine Adaline Ferguson LSW, Licdc LLC

  • Children's Substance Abuse Rehabilitation Facility
  • Maple Heights, OH
  • NPI 1679298491
  NPD Authorized official

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

{
    "created_epoch": "1484179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669161600000",
    "number": "1831635002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18320 MAPLEBORO AVE",
            "city": "MAPLE HEIGHTS",
            "state": "OH",
            "postal_code": "441372768",
            "telephone_number": "216-727-6410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16360 BROADWAY AVE STE B101",
            "city": "MAPLE HEIGHTS",
            "state": "OH",
            "postal_code": "441372573",
            "telephone_number": "216-510-7170",
            "fax_number": "216-510-7213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "CHRISTINE",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "LICDC-LISW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-12",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.161363",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S 1201586",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2102896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0488448",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Christineadaline@keycounselorcom.onmicrosoft.com",
            "affiliation": "N",
            "endpointDescription": "Business Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "16360 Broadway Ave Ste B101",
            "city": "Maple Heights",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441372573",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Janicia Sharron Flemister, CMA
• Doris L Floyd

• Clinical Social Worker in Maple Heights, OH
• Providers in Maple Heights, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.