Active NPI
Jerome Clark
- Mental Health Counselor
- Waukegan, IL
National Provider Identifier
1013465145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 671 S Lewis Ave
Waukegan, IL 60085-6101 - Phone
- (847) 782-4000
- NPI assigned
- Sep 19, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
671 S Lewis Ave
Waukegan, IL 60085-6101
Mailing address
671 S Lewis Ave
Waukegan, IL 60085-6101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Networks
- IL HMO C-SNP
- devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
- IL PPO Downstate
- devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
- devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474243200000",
"number": "1013465145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "671 S LEWIS AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600856101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "671 S LEWIS AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600856101",
"telephone_number": "847-782-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JEROME",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-19",
"last_updated": "2016-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.