Active NPI
Serena Pesch
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1144606385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.017368
- Practice address
- 5215 N Ravenswood Ave
Ste 210
Chicago, IL 60640-1670 - Phone
- (773) 654-3179
- Fax
- (773) 973-0353
- NPI assigned
- Aug 10, 2015
- Sex
- Female
- 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 | 149.017368 | IL | Primary |
Addresses
Primary practice location
5215 N Ravenswood Ave
Ste 210
Chicago, IL 60640-1670
Mailing address
5215 N Ravenswood Ave
Ste 210
Chicago, IL 60640-1670
Phone (773) 654-3179
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151203001547 | IL | Practitioner - Clinical Social Worker | 1456651009 | Practice locations: Chicago, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
5215 N Ravenswood Ave
Suite 311
Chicago, IL 60640-1670
Phone (773) 654-3179
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.017368 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558224000000",
"number": "1144606385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5215 N RAVENSWOOD AVE",
"address_2": "STE 210",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606401670",
"telephone_number": "773-654-3179",
"fax_number": "773-973-0353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5215 N RAVENSWOOD AVE",
"address_2": "STE 210",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606401670",
"telephone_number": "773-654-3179",
"fax_number": "773-973-0353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PESCH",
"first_name": "SERENA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-10",
"last_updated": "2019-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.017368",
"primary": true
}
],
"identifiers": [],
"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 May 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.