Individual provider Active NPI

Omar Guzman

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1114453974
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149-019421 Issued in IL
Practice address
5958 S Marshfield Ave
Chicago, IL 60636-1742
Phone
(773) 964-8501
NPI assigned
May 11, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X IL
Clinical Social Worker 1041C0700X 149-019421 IL Primary

Addresses

Primary practice location

5958 S Marshfield Ave
Chicago, IL 60636-1742

Mailing address

5145 S Harding Ave
Chicago, IL 60632-3710
Phone (773) 964-8501

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
I20181003003010 IL Practitioner - Clinical Social Worker 7517219413 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook CountyGroup PAC ID 2860398088, 770 clinicians

Practice addresses (Care Compare)

1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292

Merit-based Incentive Payment System (MIPS)

Final score
95.11 of 100Reported as group
Quality
74.7
Promoting interoperability
100
Improvement activities
40
Cost
85.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149-019421ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Friend Family Health Center Inc Current Accepting new patients
Friend Family Health Center, Inc CurrentSince Jun 16, 2018 Accepting new patients
Cook County Current Accepting new patients
Friend Family Health Center Inc CurrentSince Jun 16, 2018 Accepting new patients
Cook County CurrentSince Sep 14, 2023 Accepting new patients
Cook County CurrentSince Sep 14, 2023 Accepting new patients

Locations

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

800 E 55th St
Chicago, IL 60615
Phone (773) 702-2193

1522 E 63rd St
Chicago, IL 60637
Phone (773) 795-2260

Organizations & group practices 6

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": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1114453974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5145 S HARDING AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606323710",
            "telephone_number": "773-964-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5958 S MARSHFIELD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606361742",
            "telephone_number": "773-964-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUZMAN",
        "first_name": "OMAR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-11",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-019421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.