NPIMap

Individual provider Active NPI

Carl Richard Coslow

  • Clinical Social Worker
  • Fort Wayne, IN
National Provider Identifier
1861421620
Registry record updated Dec 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34000209A Issued in IN
Practice address
4656 W Jefferson Blvd
Ste 285
Fort Wayne, IN 46804
Phone
(260) 422-9372
Fax
(260) 422-0843
NPI assigned
Jul 2, 2006
Last updated
Dec 2, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2008

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 34000209A IN Primary

Addresses

Primary practice location

4656 W Jefferson Blvd
Ste 285
Fort Wayne, IN 46804

Mailing address

4656 W Jefferson Blvd
Ste 285
Fort Wayne, IN 46804
Phone (260) 422-9372

Other identifiers 5

IdentifierTypeStateIssuer
000000143216OtherINANTHEM
4405313OtherINAETNA
200806690AMedicaidIN
280482OtherINVALUE OPTIONS
075209000OtherINMAGELLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34000209AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Jan C Boggs Inc Clinical Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228176000000",
    "number": "1861421620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4656 W JEFFERSON BLVD",
            "address_2": "STE 285",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-422-9372",
            "fax_number": "260-422-0843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4656 W JEFFERSON BLVD",
            "address_2": "STE 285",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-422-9372",
            "fax_number": "260-422-0843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSLOW",
        "first_name": "CARL",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-02",
        "last_updated": "2008-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34000209A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000143216",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4405313",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200806690A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "280482",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "075209000",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.