Individual provider Active NPI

Donald E Jones, LCSW

  • Clinical Social Worker
  • Crystal Lake, IL
National Provider Identifier
1023095346
Registry record updated Apr 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149 -- 004219 Issued in IL
Practice address
100 N Walkup Ave
Crystal Lake, IL 60014-4383
Phone
(815) 444-1090
Fax
(815) 788-1345
NPI assigned
Dec 28, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 18, 2017

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 149 -- 004219 IL Primary

Addresses

Primary practice location

100 N Walkup Ave
Crystal Lake, IL 60014-4383

Mailing address

1199 Westport RDG
Crystal Lake, IL 60014-8988
Phone (815) 455-6463

Other identifiers 2

IdentifierTypeStateIssuer
05632141OtherILBC/BS
545749OtherILVALUE OPTIONS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20050729000672 IL Practitioner - Clinical Social Worker 5092743153 Practice locations: Crystal Lake, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

457 Coventry LN
Suite 115a
Crystal Lake, IL 60014-7571
Phone (815) 444-1090

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149 -- 004219ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492473600000",
    "number": "1023095346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1199 WESTPORT RDG",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600148988",
            "telephone_number": "815-455-6463",
            "fax_number": "815-788-1345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N WALKUP AVE",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600144383",
            "telephone_number": "815-444-1090",
            "fax_number": "815-788-1345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "DONALD",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2017-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149 -- 004219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "05632141",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "545749",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.