Miss Susan Shopodock, CLINICAL SOCIAL WORK is a medicare enrolled "Social Worker - Clinical" provider in Manitowoc, Wisconsin. Her current practice location is
816 Washington St, Manitowoc, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(920) 645-3743.
Miss Susan Shopodock is licensed to practice in Wisconsin (license number 11553-123) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1225743230.
Healthcare Provider's Profile
| Full Name | Miss Susan Shopodock |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 816 Washington St, Manitowoc, Wisconsin |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1225743230
- Provider Enumeration Date: 01/16/2023
- Last Update Date: 07/24/2024
Medicare PECOS Information:
- PECOS PAC ID: 2860929379
- Enrollment ID: I20241223001300
Medical Identifiers
Medical identifiers for Miss Susan Shopodock such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1225743230 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 19773 (Wisconsin) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 104100000X | Social Worker | 11553-123 (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | 11553-123 (Wisconsin) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Miss Susan Shopodock allows following entities to bill medicare on her behalf.
| Entity Name | Summit Clinical Services Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1417605551
PECOS PAC ID: 4486095486
Enrollment ID: O20240508001756 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Miss Susan Shopodock is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Miss Susan Shopodock, CLINICAL SOCIAL WORK
816 Washington St,
Manitowoc, WI 54220-4537
Ph: (920) 652-6065 | Miss Susan Shopodock, CLINICAL SOCIAL WORK
816 Washington St,
Manitowoc, WI 54220-4537
Ph: (920) 645-3743 |
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