Individual provider Active NPI

John Hurd, LCSW

  • Clinical Social Worker
  • Park Ridge, IL
National Provider Identifier
1194123703
Registry record updated Dec 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.016950 Issued in IL
Practice address
621 S Knight Ave
Park Ridge, IL 60068-4405
Phone
(847) 692-3183
NPI assigned
Dec 12, 2014
Last updated
Dec 12, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2014

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 149.016950 IL Primary

Addresses

Primary practice location

621 S Knight Ave
Park Ridge, IL 60068-4405

Mailing address

621 S Knight Ave
Park Ridge, IL 60068-4405
Phone (847) 692-3183

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
I20150108000424 IL Practitioner - Clinical Social Worker 0345563870 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Chicago Integrative Center for Psychology LLCGroup PAC ID 6800288754, 10 clinicians

Practice addresses (Care Compare)

8707 Skokie Blvd
Suite 210
Skokie, IL 60077-2272
Phone (847) 615-1698

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.016950ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Chicago Integrative Center for Psychology LLC CurrentSince Jul 27, 2022 Accepting new patients

Locations

900 N Shore Dr
Ste 120
Lake Bluff, IL 60044
Phone (847) 615-1698

8707 Skokie Blvd
Ste 210
Skokie, IL 60077
Phone (847) 615-1698

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": "1418342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418342400000",
    "number": "1194123703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S KNIGHT AVE",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684405",
            "telephone_number": "847-692-3183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S KNIGHT AVE",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684405",
            "telephone_number": "847-692-3183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HURD",
        "first_name": "JOHN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-12-12",
        "last_updated": "2014-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.016950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.