Randolph Paul Andersen, LCSW
Individual provider Active NPI Clinical Social Worker · Wheaton, IL
NPI 1083095392 · NPPES record last updated Sep 5, 2024
Key facts
- NPI
- 1083095392
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149027573 (IL)
- Practice address
- 128 S County Farm Rd Ste C
Wheaton, IL 60187-2400 - Phone
- (630) 447-8818
- NPI assigned
- Jun 11, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Psychiatry of Texas PLLC
Practice addresses (Care Compare)
14484 John Humphrey Dr
Orland Park, IL 60462-2638
Phone 8328694818235
5446 N Academy Blvd
Suite 102
Colorado Springs, CO 80918-3668
Phone (832) 869-4818
7877 Willow Chase Blvd
Houston, TX 77070-5934
Phone 8328694818235
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in TX, CO, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220826001326 | TX | Practitioner - Clinical Social Worker | 8628452562 | Reassigns benefits to 2 organizations |
| I20220830002321 | CO | Practitioner - Clinical Social Worker | 8628452562 | Reassigns benefits to 3 organizations |
| I20251009003776 | IL | Practitioner - Clinical Social Worker | 8628452562 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116741 | TX | MD | Licensed Vocational Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychplus Medical Associates, PLLC | Current |
Accepting new patients | |
| Panahi Counseling, PC | Current |
Accepting new patients | |
| Community Reach Center, Inc | Current |
Accepting new patients | |
| Psychiatry of Texas PLLC | Current |
Accepting new patients | |
| Community Reach Center, Inc | Current |
Accepting new patients |
Locations
5446 N Academy Blvd
Ste 102
Colorado Springs, CO 80918
Phone (719) 224-8690
4371 E 72nd Ave
Commerce City, CO 80022
Phone (303) 286-4973
1554 N Emerson St
Unit 5
Denver, CO 80218
Phone (720) 358-2862
6169 S Balsam Way
Ste 320
Littleton, CO 80123
Phone (303) 973-3668
8931 Huron St
Thornton, CO 80260
Phone (303) 853-3433
1870 W 122nd Ave
Ste 100
Westminster, CO 80234
Phone (303) 853-3800
1431 McHenry Rd
Ste 105
Buffalo Grove, IL 60089
Phone (708) 286-1264
14484 John Humphrey Dr
Orland Park, IL 60462
Phone (708) 741-2325
128 S County Farm Rd
Ste C
Wheaton, IL 60187
Phone (630) 423-2350
12180 N Mopac Expy
Ste B
Austin, TX 78758
Phone (512) 836-4999
12221 Merit Dr
Ste 450
Dallas, TX 75251
Phone (214) 217-1900
2110 W Trenton Rd
Ste A
Edinburg, TX 78539
Phone (956) 289-8200
3100 Alliance Town Ctr
Fort Worth, TX 76177
Phone (409) 938-5166
7877 Willow Chase Blvd
Houston, TX 77070
Phone 8328694818109
23838 Highway 59 N
Kingwood, TX 77339
Phone (832) 869-4814
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149027573 | IL | Yes |
Addresses
Primary practice location
128 S County Farm Rd Ste C
Wheaton, IL 60187-2400
Mailing address
128 S County Farm Rd Ste C
Wheaton, IL 60187-2400
Phone (630) 447-8818
Other providers in Wheaton, IL
- American Drug Stores LLC
- Alkaben Dwijen Amin
- Diane Amstutz
- Donna Ruth Amstutz
- Sonika Anand
- Shannon Andersen
- Susan J Anderson-Nelson
- Africa C Anderson
- Cindy Anderson
- Dionna Anderson
All providers in Wheaton, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.