Shannon Nicole Maximov, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149023293 Issued in IL

Practice address

900 N Westmoreland Rd Ste 114
Lake Forest, IL 60045-1680

Phone

(312) 695-7542

Fax

(312) 694-2535

NPI assigned

Feb 3, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Shannon Nicole Elkins Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, IL2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.19 of 100Reported as apm

Quality

83.05

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Northwestern Medical Faculty Foundation

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, IL

  Medicare reassignment NPD
• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Clinical

  Medicare reassignment NPD
• Northwestern Medical Faculty Foundation

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD

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

{
    "created_epoch": "1170460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1245378835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N WESTMORELAND RD STE 114",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451680",
            "telephone_number": "312-695-7542",
            "fax_number": "312-694-2535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N WESTMORELAND RD STE 114",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451680",
            "telephone_number": "312-695-7542",
            "fax_number": "312-694-2535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXIMOV",
        "first_name": "SHANNON",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-03",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149023293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "710 S Broadway",
            "city": "Walnut Creek",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945965294",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "ELKINS",
            "middle_name": "NICOLE",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mass Medical, S.C.
• Karen J Mass, MD
• Mark E Mass, MD
• Kaitlin E Mastalerz, PA-C
• Manu M Mathew, OTD
• Allison May, AU.D.
• Kristen Mayer Cocagne, PA-C
• Peter M MC Cool, MD
• June McCallister, PT
• William McCune, MD

• Clinical Social Worker in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.