Individual provider Active NPI

Daniel Sommer, LCSW

  • Clinical Social Worker
  • Rockford, IL
National Provider Identifier
1265470496
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149019280 Issued in IL
Practice address
2823 Glenwood Avenue
Rockford, IL 61101
Phone
(815) 968-5342
Fax
(815) 968-4656
NPI assigned
Jun 2, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149019280 IL Primary
Clinical Social Worker 1041C0700X 34004801A IN

Addresses

Primary practice location

2823 Glenwood Avenue
Rockford, IL 61101

Mailing address

2823 Glenwood Avenue
Rockford, IL 61101
Phone (815) 968-5342

Other identifiers 1

IdentifierTypeStateIssuer
000000383548OtherINANTHEM BC/BS PROVIDER NUM

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
I20180227003007 IL Practitioner - Clinical Social Worker 3072644533 Practice locations: Rockford, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2721 Glenwood CT
Rockford, IL 61101-3507
Phone (815) 968-5342

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149019280ILMDClinical Social Worker
34004801AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Glenwood Center LTD Single Specialty CurrentSince Jul 24, 2022 Accepting new patients
Luzio & Associates Behavioral Services, Inc. Clinical PastSince Jun 3, 2010 Accepting new patients

Locations

2721 Glenwood Ct
Rockford, IL 61101
Phone (815) 968-5342

Organizations & group practices 2

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": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1265470496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2823 GLENWOOD AVENUE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61101",
            "telephone_number": "815-968-5342",
            "fax_number": "815-968-4656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2823 GLENWOOD AVENUE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61101",
            "telephone_number": "815-968-5342",
            "fax_number": "815-968-4656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOMMER",
        "first_name": "DANIEL",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149019280",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34004801A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS PROVIDER NUM",
            "identifier": "000000383548",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.