Active NPI
David Gerould Markham, L.C.S.W.
- Clinical Social Worker
- Brockport, NY
National Provider Identifier
1972628337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- PRO13588-1
- Practice address
- 58 Market St
Brockport, NY 14420-1934 - Phone
- (585) 637-0040
- NPI assigned
- Mar 21, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | PRO13588-1 | NY | Primary |
Addresses
Primary practice location
58 Market St
Brockport, NY 14420-1934
Mailing address
58 Market St
Brockport, NY 14420-1934
Phone (585) 637-0040
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100340FK | Other | NY | PREFERRED CARE |
| P0010013588 | Other | NY | EXCELLUS BLUE CROSS AND B |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240731001574 | NY | Practitioner - Clinical Social Worker | 8628410818 | Practice locations: Brockport, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1972
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
13 Water St
Brockport, NY 14420-1964
Phone (585) 637-0040
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PRO13588-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972628337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "58 MARKET ST",
"city": "BROCKPORT",
"state": "NY",
"postal_code": "144201934",
"telephone_number": "585-637-0040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "58 MARKET ST",
"city": "BROCKPORT",
"state": "NY",
"postal_code": "144201934",
"telephone_number": "585-637-0040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARKHAM",
"first_name": "DAVID",
"middle_name": "GEROULD",
"name_prefix": "Mr.",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "PRO13588-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CARE",
"identifier": "100340FK",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EXCELLUS BLUE CROSS AND B",
"identifier": "P0010013588",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.