Individual provider Active NPI

Timothy John Schwaller, MSSW

  • Clinical Social Worker
  • West Allis, WI
National Provider Identifier
1851542864
Registry record updated Oct 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
4131-123 Issued in WI
Practice address
1126 S 70TH St
West Allis, WI 53214-3151
Phone
(415) 727-7289
NPI assigned
Oct 8, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 8, 2008

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 4131-123 WI Primary
School Social Worker 1041S0200X 050912 WI

Addresses

Primary practice location

1126 S 70TH St
West Allis, WI 53214-3151

Mailing address

568 N 105TH St
Wauwatosa, WI 53226-4330
Phone (414) 774-7135

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
I20120221000866 WI Practitioner - Clinical Social Worker 5698933737 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Services Group Inc.Group PAC ID 8224296454, 22 clinicians

Practice addresses (Care Compare)

1205 S 70TH St
Suite 301
West Allis, WI 53214-3167
Phone (414) 475-2788

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
050912WIMDSchool Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Services Group, Inc. CurrentSince Sep 27, 2011 Accepting new patients

Locations

2108 63rd St
Kenosha, WI 53143

6233 39th Ave
Kenosha, WI 53142
Phone (262) 654-1004

1205 S 70th St
Ste 301
West Allis, WI 53214
Phone (414) 475-2788

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": "1223424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223424000000",
    "number": "1851542864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 N 105TH ST",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264330",
            "telephone_number": "414-774-7135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 S 70TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532143151",
            "telephone_number": "415-727-7289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHWALLER",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "MSSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-08",
        "last_updated": "2008-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "4131-123",
            "primary": true
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "WI",
            "license": "050912",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Allis, WI

Sources for this page

Verify at the official NPI Registry.