Individual provider Active NPI

Chelsea Smith, LCSW

  • Clinical Social Worker
  • Dixon, IL
National Provider Identifier
1184187692
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.026090 Issued in IL
Practice address
325 Illinois RT 2
Dixon, IL 61021-9118
Phone
(815) 284-6611
NPI assigned
Apr 11, 2019
Last updated
Nov 3, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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 149.026090 IL Primary

Addresses

Primary practice location

325 Illinois RT 2
Dixon, IL 61021-9118

Mailing address

309 N Elm St
Franklin Grove, IL 61031-9543

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
I20240105001384 IL Practitioner - Clinical Social Worker 4880045673 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sinnissippi Centers IncGroup PAC ID 3476459876, 32 clinicians

Practice addresses (Care Compare)

325 Il Route 2
Dixon, IL 61021-9118
Phone 81528466118220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.026090ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Sinnissippi Centers, Inc. Current Accepting new patients
Sinnissippi Centers, Inc. CurrentSince Nov 17, 2023 Accepting new patients
Sinnissippi Centers, Inc. CurrentSince Nov 17, 2023 Accepting new patients
Sinnissippi Centers, Inc. Past Accepting new patients

Locations

325 Il Route 2
Dixon, IL 61021
Phone (815) 288-6611

325 Illinois Route 2
Dixon, IL 61021
Phone (815) 562-3801

Rte 2 325 Illinois
Dixon, IL 61021

1321 N 7th St
Rochelle, IL 61068
Phone (815) 562-3801

Organizations & group practices 4

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": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1184187692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 N ELM ST",
            "city": "FRANKLIN GROVE",
            "state": "IL",
            "postal_code": "610319543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 ILLINOIS RT 2",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610219118",
            "telephone_number": "815-284-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CHELSEA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.026090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dixon, IL

Sources for this page

Verify at the official NPI Registry.