Individual provider Active NPI

Karin Elisabeth Wile, MSW

  • Clinical Social Worker
  • Stony Brook, NY
National Provider Identifier
1912096025
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
PR020116 Issued in NY
Practice address
34 Erland Road
Stony Brook, NY 11790-1125
Phone
(631) 751-2090
Fax
(631) 689-1922
NPI assigned
Oct 12, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 PR020116 NY Primary

Addresses

Primary practice location

34 Erland Road
Stony Brook, NY 11790-1125

Mailing address

34 Erland Road
Stony Brook, NY 11790-1125
Phone (631) 751-2090

Other identifiers 5

IdentifierTypeStateIssuer
P271870OtherNYOXFORD
0004417970OtherAETNA
0070506OtherGHI
179677OtherMHN
090165OtherNYVALUE OPTIONS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20101206000116 NY Practitioner - Clinical Social Worker 3971790817 Practice locations: South Setauket, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1 Jefferson Ferry Dr
Apt 6178
South Setauket, NY 11720-4727
Phone (631) 428-4589

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PR020116NYMDClinical Social Worker
020116NYMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912096025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 ERLAND ROAD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117901125",
            "telephone_number": "631-751-2090",
            "fax_number": "631-689-1922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 ERLAND ROAD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117901125",
            "telephone_number": "631-751-2090",
            "fax_number": "631-689-1922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILE",
        "first_name": "KARIN",
        "middle_name": "ELISABETH",
        "name_prefix": "Mrs.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "PR020116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P271870",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0004417970",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0070506",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "179677",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "090165",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.