Individual provider Active NPI

Kristin L Krebs, LCSW

  • Clinical Social Worker
  • Edwardsville, IL
National Provider Identifier
1225021033
Registry record updated Jul 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149008998 Issued in IL
Practice address
103A South Pointe Drive
Edwardsville, IL 62025-3780
Phone
(618) 656-2000
Fax
(618) 656-1169
NPI assigned
Aug 26, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2012

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 149008998 IL Primary

Addresses

Primary practice location

103A South Pointe Drive
Edwardsville, IL 62025-3780

Mailing address

PO Box 790
Edwardsville, IL 62025-0790
Phone (618) 692-9640

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
I20050323000637 IL Practitioner - Clinical Social Worker 8426004458 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois Associates Psychiatry P CGroup PAC ID 4880649045, 2 clinicians

Practice addresses (Care Compare)

103 Southpointe Dr
Suite a
Edwardsville, IL 62025-3780
Phone (618) 656-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Associates Psychiatry P C Clinical CurrentSince May 1, 2005 Accepting new patients

Locations

103 Southpointe Dr
Ste A
Edwardsville, IL 62025
Phone (618) 407-9363

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": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343347200000",
    "number": "1225021033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620250790",
            "telephone_number": "618-692-9640",
            "fax_number": "618-692-9643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103A SOUTH POINTE DRIVE",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253780",
            "telephone_number": "618-656-2000",
            "fax_number": "618-656-1169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREBS",
        "first_name": "KRISTIN",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-26",
        "last_updated": "2012-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149008998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwardsville, IL

Sources for this page

Verify at the official NPI Registry.