Individual provider Active NPI

Debbie N Douglas, LCSW

  • Clinical Social Worker
  • Derby, CT
National Provider Identifier
1912167164
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
005804 Issued in CT
Practice address
130 Division Street
Griffin Hospital
Derby, CT 06418
Phone
(203) 732-7550
Fax
(203) 732-1550
NPI assigned
Jun 11, 2008
Last updated
Jun 11, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 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 005804 CT Primary

Addresses

Primary practice location

130 Division Street
Griffin Hospital
Derby, CT 06418

Mailing address

130 Division Street
Griffin Hospital
Derby, CT 06418
Phone (203) 732-7550

Other identifiers 1

IdentifierTypeStateIssuer
005804OtherCTSTATE LICENCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20080924000464 CT Practitioner - Clinical Social Worker 7911071725 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Connecticut School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midstate Medical CenterGroup PAC ID 7416840699, 187 clinicians

Practice addresses (Care Compare)

100 Grand St
New Britain, CT 06052-2016
Phone (860) 224-5121

435 Lewis Ave
Meriden, CT 06451-2101
Phone (203) 238-7747

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.06 of 100Reported as group
Quality
87.5
Promoting interoperability
100
Improvement activities
40
Cost
77.51

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Hospital of Central Connecticut at New Britain General and Bradley CurrentSince Sep 11, 2024 Accepting new patients
Midstate Medical Center Current Accepting new patients
Midstate Medical Center CurrentSince Sep 11, 2024 Accepting new patients
Midstate Medical Center CurrentSince Sep 11, 2024 Accepting new patients
The Hospital of Central Connecticut at New Britain General and Bradley CurrentSince Sep 11, 2024 Accepting new patients

Locations

435 Lewis Ave
Meriden, CT 06451
Phone (203) 284-1340

100 Grand St
New Britain, CT 06052
Phone (860) 224-5011

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Organizations & group practices 5

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213142400000",
    "number": "1912167164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 DIVISION STREET",
            "address_2": "GRIFFIN HOSPITAL",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "06418",
            "telephone_number": "203-732-7550",
            "fax_number": "203-732-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 DIVISION STREET",
            "address_2": "GRIFFIN HOSPITAL",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "06418",
            "telephone_number": "203-732-7550",
            "fax_number": "203-732-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "DEBBIE",
        "middle_name": "N",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-11",
        "last_updated": "2008-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "005804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENCE",
            "identifier": "005804",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, CT

Sources for this page

Verify at the official NPI Registry.