Active NPI
Jeremy Brook Hisaw, LCSW
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1083701429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 1 E Superior St
Suite #310
Chicago, IL 60611-2507 - Phone
- (773) 403-0473
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- 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
1 E Superior St
Suite #310
Chicago, IL 60611-2507
Mailing address
1733 W Crystal St
Unit B
Chicago, IL 60622-8801
Phone (773) 403-0473
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1636404 | Other | IL | BC/BS PROVIDER NUMBER |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.011629 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083701429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1733 W CRYSTAL ST",
"address_2": "UNIT B",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606228801",
"telephone_number": "773-403-0473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 E SUPERIOR ST",
"address_2": "SUITE #310",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606112507",
"telephone_number": "773-403-0473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HISAW",
"first_name": "JEREMY",
"middle_name": "BROOK",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-06",
"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": "BC/BS PROVIDER NUMBER",
"identifier": "1636404",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, 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.