Amber Fawn Gentrysouthard, M.S.W, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW 60072190 Issued in WA

Practice address

325 E Pioneer
Puyallup, WA 98372-3265

Phone

(253) 445-8120

Fax

(253) 697-3730

NPI assigned

Apr 10, 2008

Last updated

Apr 26, 2012By 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

Medicare fee-for-service enrollment

Enrolled in WA

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, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Multicare Health SystemGroup PAC ID 7719899897, 2,312 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.

• Multicare Health System

  dba Multicare Neurological Surgery

  • Neurological Surgery Physician
  • Tacoma, WA
  • NPI 1497766638
  Medicare reassignment Care Compare group NPD
• Multicare Health System

  dba MultiCare Deaconess Retail Pharmacy

  • Community/Retail Pharmacy
  • Spokane, WA
  • NPI 1396594875
  NPD
• Multicare Health System

  dba Pediatrics Northwest by Mary Bridge Children's

  • Pediatrics Physician
  • Federal Way, WA
  • NPI 1407409741
  NPD

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

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335398400000",
    "number": "1902079924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 E PIONEER",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723265",
            "telephone_number": "253-445-8120",
            "fax_number": "253-697-3730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 E PIONEER",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723265",
            "telephone_number": "253-445-8120",
            "fax_number": "253-697-3730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENTRYSOUTHARD",
        "first_name": "AMBER",
        "middle_name": "FAWN",
        "credential": "M.S.W, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-10",
        "last_updated": "2012-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW 60072190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genesis Chiropractic Rehabilitation NW Inc
• Nadira Genis, LMP
• Genoa Healthcare, LLC (Genoa Healthcare)
• Katelyn Rae Genova, PA-C
• Ceara Nicole Gentry, LMT
• George G. Ghosn D.D.S.,P.S.
• Jaya George, RPH
• Conor T Geraghty
• Dean Raymond Gerimonte II, D.C.
• Neva Anne Gerke, LM, MSM

• Clinical Social Worker in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2012; 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.