Betty S Thunder, ADVANCED PRACTICE SO

Primary specialty

Social WorkerTaxonomy code 104100000X

License

677121 Issued in WI

Practice address

5409 Everybody's Road
Forest County Potawatomi Health & Wellness Center
Crandon, WI 54520

Phone

(715) 478-4300

Fax

(715) 478-4490

NPI assigned

Aug 4, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ms. Betty S Bow Former name

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

Specialty

Clinical Social Worker

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Lakes Community Health Center IncGroup PAC ID 0840366654, 104 clinicians

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Lakes Community Health Center, Inc

  dba NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Iron River, WI
  • NPI 1811178825
  Medicare reassignment Care Compare group NPD
• The Lakes Community Health Center, Inc

  dba NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • White Lake, WI
  • NPI 1679983423
  NPD

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881602761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 396",
            "address_2": "5409 EVERYBODY'S ROAD FOREST COUNTY POTAWATOMI HEALTH",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "54520",
            "telephone_number": "715-478-4300",
            "fax_number": "715-478-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5409 EVERYBODY'S ROAD",
            "address_2": "FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "54520",
            "telephone_number": "715-478-4300",
            "fax_number": "715-478-4490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THUNDER",
        "first_name": "BETTY",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "ADVANCED PRACTICE SO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "677121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39700200",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURITY HEALTH PLAN",
            "identifier": "66628",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETTY",
            "last_name": "BOW",
            "middle_name": "S",
            "prefix": "MS.",
            "credential": "APSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jodi L Space, APNP
• Shalynn Sprink
• Jennifer Lynn Stein, FNP-C
• Tina Irene Taylor
• The Center for Human Restoration, Inc
• Kayla Charlene Van Cleve, RN
• Eve Louise Van Harpen, DDS
• Zatrina Marie Vollmar
• Jacob Ryan Wagner, D.D.S.
• Renee Lynn Walden, OD

• Social Worker in Crandon, WI
• Providers in Crandon, WI by specialty
• Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.