Individual provider Active NPI

Susan A Baker Carr, LCSW-R

  • Clinical Social Worker
  • Ithaca, NY
National Provider Identifier
1982773768
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
071718 Issued in NY
Practice address
109 S Albany St Ste 101
Ithaca, NY 14850-5482
Phone
(607) 379-3600
Fax
(607) 277-7690
NPI assigned
Nov 7, 2006
Last updated
Nov 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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 071718 NY Primary

Addresses

Primary practice location

109 S Albany St Ste 101
Ithaca, NY 14850-5482

Mailing address

120 E Buffalo St
Ithaca, NY 14850-4266
Phone (607) 379-3600

Other identifiers 2

IdentifierTypeStateIssuer
11638742OtherNYCAQH
20448Z080OtherNYBCBS

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070531000258 NY Practitioner - Clinical Social Worker 9335247279 Practice locations: Ithaca, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

109 S Albany St
Suite 101
Ithaca, NY 14850-5482
Phone (607) 379-3600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071718NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1982773768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 E BUFFALO ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504266",
            "telephone_number": "607-379-3600",
            "fax_number": "607-277-7690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S ALBANY ST STE 101",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505482",
            "telephone_number": "607-379-3600",
            "fax_number": "607-277-7690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER CARR",
        "first_name": "SUSAN",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "071718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11638742",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "20448Z080",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

Verify at the official NPI Registry.