Thomas Robert Undine, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.013059 Issued in IL

Practice address

4958 N Milwaukee Ave
Chicago, IL 60630

Phone

(773) 207-8500

NPI assigned

Jun 5, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Memorial Medical Center IncGroup PAC ID 8022000447, 80 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tamarack Health Ashland Medical Center Hospital, Ashland, WI, CCN 521359

Merit-based Incentive Payment System (MIPS)

Final score

86.19 of 100Reported as group

Quality

74.89

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.

• Memorial Medical Center Inc

  • Critical Access Hospital
  • Ashland, WI
  • NPI 1437179231
  Medicare reassignment Care Compare group NPD
• Memorial Medical Center Inc

  • Rural Health Clinic/Center
  • Ashland, WI
  • NPI 1770255937
  NPD
• Center for Grief Recovery and Sibling Loss

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1316046386
  NPD (past)
• Therapeutic Strategies, Inc

  • Counselor
  • Downers Grove, IL
  • NPI 1346316593

  Clinical

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Memorial Medical Center Inc

  • Critical Access Hospital
  • Ashland, WI
  • NPI 1437179231
  Care Compare affiliation

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216598400000",
    "number": "1245499151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 FINLEY RD",
            "address_2": "SUITE 102",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151041",
            "telephone_number": "630-495-6800",
            "fax_number": "630-495-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4958 N MILWAUKEE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60630",
            "telephone_number": "773-207-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDINE",
        "first_name": "THOMAS",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-05",
        "last_updated": "2008-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "IL",
            "license": "2239902",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.013059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nichola Underwood
• Sandra D Underwood
• Summer Valentine Underwood, LPC, MS
• Undine and Associates
• Undine and Associates
• Unfettered Psychotherapy & Consulting LLC
• Unfragmented Wellness LLC
• Unfurl Acupuncture, LLC
• Chana Ungar
• Joy Ann Ungaretti, M.D.

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, 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 Jul 21, 2008; 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.