Individual provider Active NPI

Lisa Beth Courchaine, LCSW

  • Clinical Social Worker
  • Columbus, WI
National Provider Identifier
1851725626
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
8428-123 Issued in WI
Practice address
1515 Park Ave
Columbus, WI 53925-2402
Phone
(920) 623-2200
NPI assigned
Aug 28, 2013
Last updated
May 17, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

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 8428-123 WI Primary

Addresses

Primary practice location

1515 Park Ave
Columbus, WI 53925-2402

Mailing address

1515 Park Ave
Columbus, WI 53925-2402
Phone (920) 623-2200

Other identifiers 2

IdentifierTypeStateIssuer
8428-123OtherWILICENSE
100032648MedicaidWI

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
I20190523000458 WI Practitioner - Clinical Social Worker 5597008102 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prairie Ridge Health IncGroup PAC ID 6800791484, 70 clinicians

Practice addresses (Care Compare)

1515 Park Ave
Columbus, WI 53925-1618
Phone (920) 623-2200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8428-123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Prairie Ridge Health, Inc. Current Accepting new patients
Prairie Ridge Health Inc. CurrentSince May 17, 2023 Accepting new patients
Prairie Ridge Health, Inc. CurrentSince May 17, 2023 Accepting new patients

Locations

1515 Park Ave
Columbus, WI 53925
Phone (920) 623-1200

Organizations & group practices 4

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1377648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1851725626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COURCHAINE",
        "first_name": "LISA",
        "middle_name": "BETH",
        "name_prefix": "Miss",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-28",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "8428-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "8428-123",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100032648",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, WI

Sources for this page

Verify at the official NPI Registry.