Active NPI
Michael John Trader, L.C.S.W.
- Clinical Social Worker
- Rockford, IL
National Provider Identifier
1053474460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 129 Phelps Ave
Suite 818
Rockford, IL 61108-2453 - Phone
- (815) 229-6316
- Fax
- (815) 229-6316
- NPI assigned
- Dec 18, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | IL | Primary |
Addresses
Primary practice location
129 Phelps Ave
Suite 818
Rockford, IL 61108-2453
Mailing address
129 S Phelps Ave
Suite 818
Rockford, IL 61108-2453
Phone (815) 229-6316
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0010171232 | Other | IL | BCBS OF ILLINOIS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149000557 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053474460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "129 S PHELPS AVE",
"address_2": "SUITE 818",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082453",
"telephone_number": "815-229-6316",
"fax_number": "815-229-6316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "129 PHELPS AVE",
"address_2": "SUITE 818",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082453",
"telephone_number": "815-229-6316",
"fax_number": "815-229-6316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRADER",
"first_name": "MICHAEL",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF ILLINOIS",
"identifier": "0010171232",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.