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MATTHEW MARCOS BACCA LSW
NPI 1538825922
Social Worker in Fort Drum, NY

Active since November 10, 2021PECOS Enrolled
11050 MOUNT BELVEDERE BLVD, FORT DRUM, NY 13602(719) 634-8365 Get Directions Write a Review

NPPES record last updated: August 11, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 11, 2025, Feb 9, 2023, Nov 10, 2021 (3 updates tracked since 2021).

About Matthew Marcos Bacca Lsw NPPES

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

MATTHEW MARCOS BACCA LSW (NPI 1538825922) is an individual social worker in Fort Drum, New York, licensed in Colorado (LSW.009924321) and active in the NPI registry since November 2021. He is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1538825922
Entity TypeIndividualMale
Primary Taxonomy104100000X
Provider Legal NameMATTHEW MARCOS BACCACredential: LSW
Location Address11050 MOUNT BELVEDERE BLVDFort Drum, NY 13602-5438
Mailing Address11050 Mount Belvedere BlvdFort Drum, NY 13602-5438 · (315) 772-6976
Phone(719) 634-8365
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateNovember 10, 2021
Last NPPES UpdateAugust 11, 20253 updates tracked since enumeration
NPPES CertifiedAugust 11, 2025
✔ NPI 1538825922 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers
Taxonomy Code104100000X
License✔ Licensed in CO · LSW.009924321
Definition
A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.
11050 MOUNT BELVEDERE BLVD, Fort Drum, NY 13602
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Matthew Marcos Bacca Lsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5496239790
PECOS Enrollment IDI20260325000402
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 Reassignment

Medicare enrollment records show Matthew Bacca reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Denver Wellness Associates
1,524 mi
Child & Adolescent Psychiatry
400 S COLORADO BLVD STE 600
Denver, CO 80246
  • Reassigned Medicare billing, Colorado enrollment
  • 41 clinicians in this Medicare group
NPI 1144707878 (720) 724-3668

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

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.

DR. LAUREL JARVIS PH.D.
Psychologist (Clinical)
11050 MOUNT BELVEDERE BLVD, BEHAVIORAL HEALTH DEPARTMENT, MEDDAC
FORT DRUM, NY 13602
Jefferson County (315) 772-4850
DAVID LEWIS KEYES RPA-C
Physician Assistant
11050 MOUNT BELVEDERE BLVD, USA MEDDAC CREDENTIALS
FORT DRUM, NY 13602
Jefferson County (315) 772-5508
BRADY SIMPKINS PA-C
Physician Assistant
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (802) 258-0301
MS. MARY ANGELA MACCULLOCH LCSW
Social Worker (Clinical)
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (315) 772-7624
DR. ISAAC P MILLS DO
Family Medicine
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (315) 772-2778
SAVITRI MOTAPARTHI M.D.
Pediatrics
11050 MOUNT BELVEDERE BLVD, USA MEDDAC /CREDENTIALS
FORT DRUM, NY 13602
Jefferson County (315) 772-4025
DR. LUTHER ROSWELL WIEST D.O.
Family Medicine
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (315) 772-3679
MADISON GERMAN LCSW
Social Worker (Clinical)
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (315) 772-2778

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 Matthew Bacca's NPI number?

The NPI number for Matthew Bacca is 1538825922. It was assigned to this individual provider in the NPPES registry on November 10, 2021.

Where is Matthew Bacca located?

Matthew Bacca practices at 11050 Mount Belvedere Blvd, Fort Drum, NY 13602. The listed phone number is (719) 634-8365.

What is Matthew Bacca's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Is Matthew Bacca enrolled in Medicare?

Yes. Matthew Bacca is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Matthew Bacca's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Matthew Bacca reassigns Medicare benefits to Denver Wellness Associates (Denver, CO). The 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 Matthew Bacca's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Matthew Bacca was last updated on August 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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.