Individual provider Active NPI

Kara L Redshaw

  • Clinical Social Worker
  • Streator, IL
National Provider Identifier
1154997278
Registry record updated May 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149023340 Issued in IL
Practice address
2 Memory LN
Streator, IL 61364-9142
Phone
(815) 252-0803
NPI assigned
May 30, 2021
Last updated
May 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 30, 2021

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 149023340 IL Primary

Addresses

Primary practice location

2 Memory LN
Streator, IL 61364-9142

Mailing address

2 Memory LN
Streator, IL 61364-9142
Phone (815) 252-0803

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
I20211026003125 IL Practitioner - Clinical Social Worker 3779971692 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois Valley Counseling ServicesGroup PAC ID 0244467066, 8 clinicians

Practice addresses (Care Compare)

747 E Etna Rd
B
Ottawa, IL 61350-3777
Phone (815) 993-1614

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149023340ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Valley Counseling Services Clinical CurrentSince Oct 1, 2021 Accepting new patients

Locations

747 E Etna Rd
#B
Ottawa, IL 61350
Phone (815) 993-1614

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622332800000",
    "number": "1154997278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MEMORY LN",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613649142",
            "telephone_number": "815-252-0803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEMORY LN",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613649142",
            "telephone_number": "815-252-0803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDSHAW",
        "first_name": "KARA",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-30",
        "last_updated": "2021-05-30",
        "certification_date": "2021-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149023340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Streator, IL

Sources for this page

Verify at the official NPI Registry.