Individual provider Active NPI

Carrie Lynn Thomas, CSW

  • Clinical Social Worker
  • Logan, UT
National Provider Identifier
1962903377
Registry record updated May 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
10578128-3501 Issued in UT
Practice address
90 E 200 N
Logan, UT 84321-4034
Phone
(435) 752-0750
Fax
(435) 752-7433
NPI assigned
Feb 22, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2020

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 10578128-3501 UT Primary

Addresses

Primary practice location

90 E 200 N
Logan, UT 84321-4034

Mailing address

90 E 200 N
Logan, UT 84321-4034
Phone (435) 752-0750

Other identifiers 1

IdentifierTypeStateIssuer
990177601002MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20210719000510 UT Practitioner - Clinical Social Worker 9335541002 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bear River Mental Health Services IncGroup PAC ID 0840102356, 31 clinicians

Practice addresses (Care Compare)

90 E 200
Logan, UT 84321-4034
Phone (435) 752-0750

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10578128-3501UTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bear River Mental Health Services Inc CurrentSince Jul 22, 2021 Accepting new patients

Locations

663 W Hospital Rd
Brigham City, UT 84302
Phone (435) 734-9449

90 E 200 N
Logan, UT 84321
Phone (435) 752-0750

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": "1519257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1962903377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 E 200 N",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843214034",
            "telephone_number": "435-752-0750",
            "fax_number": "435-752-7433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 E 200 N",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843214034",
            "telephone_number": "435-752-0750",
            "fax_number": "435-752-7433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "CARRIE",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "CSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-22",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "10578128-3501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "990177601002",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, UT

Sources for this page

Verify at the official NPI Registry.