Individual provider Active NPI

Shawn Anthony Hayward, M.S.W., L.I.C.S.W.

  • Clinical Social Worker
  • Saint Paul, MN
National Provider Identifier
1962559658
Registry record updated Jul 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
15910 Issued in MN
Practice address
1919 University Ave W
Saint Paul, MN 55104-3453
Phone
(651) 266-7921
Fax
(651) 266-7855
NPI assigned
Jan 4, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 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 15910 MN Primary

Addresses

Primary practice location

1919 University Ave W
Saint Paul, MN 55104-3453

Mailing address

1919 University Ave W
Saint Paul, MN 55104-3453
Phone (651) 266-7921

Other identifiers 1

IdentifierTypeStateIssuer
724419300MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20050908001110 MN Practitioner - Clinical Social Worker 1850323973

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

4123 E Lake St
Minneapolis, MN 55406-2255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15910MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Family Partnership CurrentSince Jul 31, 2019 Accepting new patients

Locations

414 S 8th St
Minneapolis, MN 55404
Phone (612) 339-9101

4123 E Lake St
Minneapolis, MN 55406
Phone (612) 728-2061

1527 E Lake St
Minneapolis, MN 55407
Phone (612) 345-7175

3433 Broadway St NE
Ste 230
Minneapolis, MN 55413

Organizations & group practices 1

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": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216080000000",
    "number": "1962559658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043453",
            "telephone_number": "651-266-7921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043453",
            "telephone_number": "651-266-7921",
            "fax_number": "651-266-7855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYWARD",
        "first_name": "SHAWN",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "M.S.W., L.I.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2008-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "15910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "724419300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.