NPIMap

Individual provider Active NPI

Pemba B Bayo, LCSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1063166510
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.024221 Issued in IL
Practice address
1150 W Lunt Ave Ste B&C
Chicago, IL 60626-3520
Phone
(872) 600-2029
Fax
(855) 783-8724
NPI assigned
Feb 3, 2022
Last updated
Feb 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

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 149.024221 IL Primary

Addresses

Primary practice location

1150 W Lunt Ave Ste B&C
Chicago, IL 60626-3520

Mailing address

1096 W Pratt Blvd Apt 1S
Chicago, IL 60626-4480
Phone (872) 600-2029

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pembabayo@presentmomentjourneys.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230724001977 IL Practitioner - Clinical Social Worker 6204296122 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1150 W Lunt Ave
Suite B
Chicago, IL 60626-3520
Phone (872) 600-2029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.024221ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Present Moment Journeys LLC CurrentSince Dec 27, 2019 Accepting new patients
Tapestry 360 Health PastSince Dec 31, 2018 Accepting new patients

Locations

1150 W Lunt Ave
Ste B
Chicago, IL 60626
Phone (872) 600-2029

Ownership & related parties

All facility ownership & control disclosures 11

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tapestry 360 HealthChicago, IL, CCN 141000 Federally qualified health center Corporate Director Dec 31, 2018
Tapestry 360 HealthChicago, IL, CCN 141076 Federally qualified health center Corporate Director Dec 31, 2018
Tapestry 360 HealthChicago, IL, CCN 141116 Federally qualified health center Corporate Director Dec 31, 2018
Tapestry 360 HealthChicago, IL, CCN 141149 Federally qualified health center Corporate Director Dec 31, 2018
Tapestry 360 HealthChicago, IL, CCN 141152 Federally qualified health center Corporate Director Dec 31, 2018
Tapestry 360 HealthChicago, IL, CCN 141197 Federally qualified health center Corporate Director Dec 31, 2018
Tapestry 360 HealthChicago, IL, CCN 781825 Federally qualified health center Corporate Director Dec 31, 2018
Tapestry 360 HealthChicago, IL, CCN 781849 Federally qualified health center Corporate Director Dec 31, 2020
Tapestry 360 HealthChicago, IL, CCN 781863 Federally qualified health center Corporate Director Dec 31, 2018
Tapestry 360 HealthSkokie, IL, CCN 781916 Federally qualified health center Corporate Director Dec 31, 2018
Tapestry 360 HealthChicago, IL, CCN C41020 Federally qualified health center Corporate Director Dec 31, 2018

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1643846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1063166510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1096 W PRATT BLVD APT 1S",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606264480",
            "telephone_number": "872-600-2029",
            "fax_number": "855-783-8724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 W LUNT AVE STE B&C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606263520",
            "telephone_number": "872-600-2029",
            "fax_number": "855-783-8724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAYO",
        "first_name": "PEMBA",
        "middle_name": "B",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-03",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.024221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pembabayo@presentmomentjourneys.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1150 W Lunt Ave Ste B&c",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606263520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.