Individual provider Active NPI

David John Carrico, LCSW

  • Clinical Social Worker
  • Bloomington, IN
National Provider Identifier
1891779989
Registry record updated Nov 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34002533A Issued in IN
Practice address
601 W 2ND St
Bloomington, IN 47403-2317
Phone
(812) 353-9250
NPI assigned
Dec 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2017

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 34002533A IN Primary

Addresses

Primary practice location

601 W 2ND St
Bloomington, IN 47403-2317

Mailing address

601 W 2ND St
Bloomington, IN 47403-2317
Phone (812) 353-9250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20101108000112 IN Practitioner - Clinical Social Worker 7214122076

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34002533AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana University Health Bloomington Inc Clinical CurrentSince Dec 1, 2017 Accepting new patients
Indiana University Health Bloomington Inc CurrentSince Dec 1, 2017 Accepting new patients

Locations

7987 Solution Ctr
Chicago, IL 60677

601 W 2nd St
Bloomington, IN 47403
Phone (812) 353-5252

727 W 2nd St
Bloomington, IN 47403
Phone (812) 353-3450

714 N Senate Ave
Ste 130
Indianapolis, IN 46202
Phone (317) 963-5582

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511222400000",
    "number": "1891779989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 W 2ND ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032317",
            "telephone_number": "812-353-9250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W 2ND ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032317",
            "telephone_number": "812-353-9250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRICO",
        "first_name": "DAVID",
        "middle_name": "JOHN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2017-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34002533A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.