Individual provider Active NPI

Andrew W Selander, MSW, LCSW

  • Clinical Social Worker
  • Rockford, IL
National Provider Identifier
1104300664
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149020604 Issued in IL
Practice address
6735 Vistagreen Way Ste 210
Rockford, IL 61107-5654
Phone
(815) 391-3055
NPI assigned
Sep 20, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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 149020604 IL Primary

Addresses

Primary practice location

6735 Vistagreen Way Ste 210
Rockford, IL 61107-5654

Mailing address

4209 Cushman Rd
Rockford, IL 61114-6109

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
I20190803000048 IL Practitioner - Clinical Social Worker 8022345768 Practice locations: Rockford, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6735 Vistagreen Way
Suite 210
Rockford, IL 61107-5654
Phone (815) 391-3055

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Forest City Counseling, LLC Clinical CurrentSince Aug 25, 2024 Accepting new patients

Locations

6735 Vistagreen Way
Ste 210
Rockford, IL 61107
Phone (815) 391-3055

7294 Argus Dr
Rockford, IL 61107
Phone (815) 391-3055

Organizations & group practices 1

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": "1537401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1104300664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4209 CUSHMAN RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611146109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6735 VISTAGREEN WAY STE 210",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075654",
            "telephone_number": "815-391-3055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELANDER",
        "first_name": "ANDREW",
        "middle_name": "W",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-20",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149020604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.