Individual provider Active NPI

Meera Vasquez, LCSW

  • Clinical Social Worker
  • Jasper, IN
National Provider Identifier
1154612398
Registry record updated Jul 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34007062A Issued in IN
Practice address
800 W 9TH St
Jasper, IN 47546
Phone
(812) 996-0437
Fax
(812) 996-0439
NPI assigned
Apr 21, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2018

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 150012225 IL
Clinical Social Worker 1041C0700X 34007062A IN Primary

Addresses

Primary practice location

800 W 9TH St
Jasper, IN 47546

Mailing address

PO Box 1028
Jasper, IN 47547-1028
Phone (812) 996-8478

Other practice location 1

3903 Indianapolis Blvd
East Chicago, IN 46312-2555
Phone (219) 392-6004

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
I20160805001111 IL Practitioner - Clinical Social Worker 0244451698 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Center for Mental Health IncGroup PAC ID 2365447232, 16 clinicians

Practice addresses (Care Compare)

3033 W Jefferson St
Suite 107
Joliet, IL 60435-5298
Phone (815) 773-0772

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
150012225ILMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Center for Mental Health Inc Clinical CurrentSince Jun 1, 2016 Accepting new patients

Locations

3033 W Jefferson St
Ste 107
Joliet, IL 60435
Phone (815) 773-0772

1801 N Mill St
Ste J
Naperville, IL 60563
Phone (630) 452-5409

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": "1303344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532476800000",
    "number": "1154612398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1028",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475471028",
            "telephone_number": "812-996-8478",
            "fax_number": "812-996-8497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W 9TH ST",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "47546",
            "telephone_number": "812-996-0437",
            "fax_number": "812-996-0439"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3903 Indianapolis Blvd",
            "address_purpose": "LOCATION",
            "city": "East Chicago",
            "state": "IN",
            "postal_code": "463122555",
            "country_code": "US",
            "telephone_number": "219-392-6004",
            "fax_number": "219-392-6998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VASQUEZ",
        "first_name": "MEERA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-21",
        "last_updated": "2018-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150012225",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007062A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, IN

Sources for this page

Verify at the official NPI Registry.