Individual provider Active NPI

Autumn Molinari, LCSW

  • Clinical Social Worker
  • Scott Afb, IL
National Provider Identifier
1124191283
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.011689 Issued in IL
Practice address
310 W Losey St
Scott Afb, IL 62225-5250
Phone
(618) 256-7667
NPI assigned
Nov 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 149.011689 IL Primary

Addresses

Primary practice location

310 W Losey St
Scott Afb, IL 62225-5250

Mailing address

85 Northview Dr
Highland, IL 62249-1077
Phone (618) 654-9248

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
I20141218001499 IL Practitioner - Clinical Social Worker 9335462506 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.011689ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Healthcare Foundation, Inc CurrentSince Nov 17, 2014 Accepting new patients
Southern Illinois Healthcare Foundation Inc CurrentSince Nov 17, 2014 Accepting new patients
Southern Illinois Healthcare Foundation Inc Current Accepting new patients

Locations

2001 State St
East St Louis, IL 62205
Phone (618) 271-0204

2166 Madison Ave
Granite City, IL 62040
Phone (618) 452-3301

Interoperability endpoints

  • Direct secure messaging: autumn.molinari.1@9559.direct.athenahealth.com

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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124191283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 NORTHVIEW DR",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491077",
            "telephone_number": "618-654-9248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-7667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLINARI",
        "first_name": "AUTUMN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.011689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scott Afb, IL

Sources for this page

Verify at the official NPI Registry.