Individual provider Active NPI

Robert Dennis Jaskula, LCSW

  • Clinical Social Worker
  • Cicero, IL
National Provider Identifier
1073859948
Registry record updated Dec 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.005621 Issued in IL
Practice address
5848 W 36TH St
Cicero, IL 60804-4259
Phone
(708) 408-8475
Fax
(708) 222-0219
NPI assigned
Dec 21, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2012

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 149.005621 IL Primary

Addresses

Primary practice location

5848 W 36TH St
Cicero, IL 60804-4259

Mailing address

5848 W 36TH St
Cicero, IL 60804-4259
Phone (708) 408-8475

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
I20240319001593 IL Practitioner - Clinical Social Worker 5294172821 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.005621ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Clinical CurrentSince Mar 14, 2024 Accepting new patients
Livindi Medical Group Illinois PLLC Clinical CurrentSince Mar 1, 2024 Accepting new patients
Livindi Medical Group Illinois PLLC Clinical CurrentSince Mar 1, 2024 Accepting new patients

Locations

605 N Michigan Ave
Fl 4
Chicago, IL 60611
Phone (773) 232-5338

1328 Main St
Crete, IL 60417
Phone (508) 416-6030

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1356048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356048000000",
    "number": "1073859948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5848 W 36TH ST",
            "city": "CICERO",
            "state": "IL",
            "postal_code": "608044259",
            "telephone_number": "708-408-8475",
            "fax_number": "708-222-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5848 W 36TH ST",
            "city": "CICERO",
            "state": "IL",
            "postal_code": "608044259",
            "telephone_number": "708-408-8475",
            "fax_number": "708-222-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JASKULA",
        "first_name": "ROBERT",
        "middle_name": "DENNIS",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-21",
        "last_updated": "2012-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.005621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cicero, IL

Sources for this page

Verify at the official NPI Registry.