Active NPI
Kathryn A Wagner
- Clinical Social Worker
- Mashpee, MA
National Provider Identifier
1952686719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 217493
- Practice address
- 107 Commercial St
Mashpee, MA 02649-6507 - Phone
- (508) 477-7090
- Fax
- (508) 477-7028
- NPI assigned
- Oct 12, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 217493 | MA | Primary |
Addresses
Primary practice location
107 Commercial St
Mashpee, MA 02649-6507
Mailing address
107 Commercial St
Mashpee, MA 02649-6507
Phone (508) 477-7090
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120120000041 | MA | Practitioner - Clinical Social Worker | 5193992857 | Practice locations: Sandwich, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
11 School St
Sandwich, MA 02563-2216
Phone (508) 245-7813
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318377600000",
"number": "1952686719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 COMMERCIAL ST",
"city": "MASHPEE",
"state": "MA",
"postal_code": "026496507",
"telephone_number": "508-477-7090",
"fax_number": "508-477-7028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 COMMERCIAL ST",
"city": "MASHPEE",
"state": "MA",
"postal_code": "026496507",
"telephone_number": "508-477-7090",
"fax_number": "508-477-7028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "KATHRYN",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-12",
"last_updated": "2011-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "217493",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mashpee, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; 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.