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SOUPHAPHONE HAGAN
NPI 1205466570
Social Worker - Clinical in Fresno, CA

Active since January 24, 2020PECOS EnrolledAccepts Medicare Assignment
496 S BARTON AVE, FRESNO, CA 93702(559) 860-4422 Get Directions Write a Review

NPPES record last updated: September 11, 2023. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Souphaphone Hagan NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUPHAPHONE HAGAN (NPI 1205466570) is an individual clinical provider in Fresno, California, licensed in California (107193) and active in the NPI registry since January 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2015).

NPPES Registry Identity

NPI1205466570
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameSOUPHAPHONE HAGAN
Location Address496 S BARTON AVEFresno, CA 93702-2985
Mailing Address516 Villa Ave Ste 2Clovis, CA 93612-0899 · (559) 283-3818
Phone(559) 860-4422
Sole ProprietorYes
Medical School CMSOtherGraduated 2015
Enumeration DateJanuary 24, 2020
Last NPPES UpdateSeptember 11, 2023
NPPES CertifiedAugust 31, 2023
✔ NPI 1205466570 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in CA · 107193
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
496 S BARTON AVE, Fresno, CA 93702
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Souphaphone Hagan is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7416336870
PECOS Enrollment IDI20220615002606
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Souphaphone Hagan reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

4evergreen Family Services Inc
6.3 mi
Mental Health
516 VILLA AVE STE 2
Clovis, CA 93612
  • Reassigned Medicare billing, California enrollment
  • 2 clinicians in this Medicare group
NPI 1134914237 (559) 760-0948
Thriveworks Clinical - California PC
182 mi
Mental Health
2804 CAMINO DOS RIOS STE 206
Thousand Oaks, CA 91320
  • Reassigned Medicare billing, California enrollment
  • 86 clinicians in this Medicare group
NPI 1801481395 (855) 284-7483

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 93702 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $58.87 – $176.60
Typical copayment $0.00 (range $14.71 – $44.15)
Most-billed visit code NA
Established Patient
$73.16 typical visit price
range $19.28 – $144.60
Typical copayment $18.29 (range $4.82 – $36.15)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ARRIETA DIONEDA BUTIHI
Licensed Vocational Nurse
496 S BARTON AVE
FRESNO, CA 93702
Fresno County (559) 860-4422
SENG HER
Community Health Worker
496 S BARTON AVE
FRESNO, CA 93702
Fresno County (559) 860-4422
JULISSA NICOLE DE LA ROSA
Day Training/Habilitation Specialist
496 S BARTON AVE
FRESNO, CA 93702
Fresno County (559) 860-4422
MR. BENJAMIN MICHAEL DUENAS LVN
Licensed Vocational Nurse
496 S BARTON AVE
FRESNO, CA 93702
Fresno County (559) 860-4422
DIANA BELL
Counselor
496 S BARTON AVE
FRESNO, CA 93702
Fresno County (559) 860-4422
LAQUISHA SHANTE EMERSON
Community Health Worker
496 S BARTON AVE
FRESNO, CA 93702
Fresno County (559) 860-4422
RICK GERARD GUZMAN
Counselor
496 S BARTON AVE
FRESNO, CA 93702
Fresno County (559) 600-2382
AERIKA MARLENE GARCIA
Community Health Worker
496 S BARTON AVE
FRESNO, CA 93702
Fresno County (559) 860-4422

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Souphaphone Hagan's NPI number?

The NPI number for Souphaphone Hagan is 1205466570. It was assigned to this individual provider in the NPPES registry on January 24, 2020.

Where is Souphaphone Hagan located?

Souphaphone Hagan practices at 496 S Barton Ave, Fresno, CA 93702. The listed phone number is (559) 860-4422.

What is Souphaphone Hagan's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Souphaphone Hagan enrolled in Medicare?

Yes. Souphaphone Hagan is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Souphaphone Hagan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Souphaphone Hagan reassigns Medicare benefits to 2 organizations: 4evergreen Family Services Inc (Clovis, CA) and Thriveworks Clinical - California PC (Thousand Oaks, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Souphaphone Hagan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Souphaphone Hagan accept?

Health plans from Blue Cross and Blue Shield of Texas list Souphaphone Hagan as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Souphaphone Hagan was last updated on September 11, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.