Matthew J Wadsworth, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-31281 Issued in ID

Practice address

717 Mission Road
Fort Hall, ID 83203-0306

Phone

(208) 237-5631

Fax

(208) 237-5796

NPI assigned

Aug 8, 2008

Last updated

Jan 9, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

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

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sound Mental Health LLCGroup PAC ID 0143752824, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Sound Mental Health LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Valdez, AK
  • NPI 1659118685
  Medicare reassignment Care Compare group NPD Authorized official
• City of Valdez

  dba Providence Valdez Counseling Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Valdez, AK
  • NPI 1962525097
  Medicare reassignment
• Providence Health & Services Washington

  dba Providence Kodiak Island Counseling Center

  • Community/Behavioral Health Agency
  • Kodiak, AK
  • NPI 1477563344
  Medicare reassignment
• Shoshone Bannock Tribes, Inc

  dba Shoshone-Bannock Community Health Center

  • Clinic/Center
  • Fort Hall, ID
  • NPI 1225414519
  NPD (past)
• Shoshone Bannock Tribes, Inc

  dba Shoshone Bannock Clinic

  • Clinic/Center
  • Fort Hall, ID
  • NPI 1801949763
  NPD (past)

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

{
    "created_epoch": "1218153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357689600000",
    "number": "1972759017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306",
            "city": "FORT HALL",
            "state": "ID",
            "postal_code": "832030306",
            "telephone_number": "208-237-5631",
            "fax_number": "208-237-5796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 MISSION ROAD",
            "city": "FORT HALL",
            "state": "ID",
            "postal_code": "832030306",
            "telephone_number": "208-237-5631",
            "fax_number": "208-237-5796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADSWORTH",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-08",
        "last_updated": "2013-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-31281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shoshone-Bannock Community Health Center (Shoshone-Bannock Tribes)
• Melissa D. Syria, LCPC
• Jesse Tellez Hernandez, NP-C
• Thomas John Troshynski, PHARMD
• James Fred Vook, M.D.

• Clinical Social Worker in Fort Hall, ID
• Providers in Fort Hall, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; 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.

Verify at the official NPI Registry.