Individual provider Active NPI

Lafayette R Bagley, LCSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1285399576
Registry record updated Feb 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.026408 Issued in IL
Practice address
2071 N Southport Ave
Chicago, IL 60614-4015
Phone
(312) 761-4707
NPI assigned
Nov 2, 2021
Last updated
Feb 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2024

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 149.026408 IL Primary

Addresses

Primary practice location

2071 N Southport Ave
Chicago, IL 60614-4015

Mailing address

6450 N Bell Ave Apt 1
Chicago, IL 60645-5583
Phone (312) 731-3625

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
I20240320001034 IL Practitioner - Clinical Social Worker 1355788878 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Loyola University of Chicago, Stritch School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

2071 N Southport Ave
Suite 100
Chicago, IL 60614-4015
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.026408ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. Clinical CurrentSince Feb 5, 2024 Accepting new patients
Psychology Specialists LTD Clinical Past Accepting new patients

Locations

808 S Eldorado Rd
Ste 102
Bloomington, IL 61704
Phone (309) 310-4636

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

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": "1635811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1285399576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6450 N BELL AVE APT 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606455583",
            "telephone_number": "312-731-3625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2071 N SOUTHPORT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606144015",
            "telephone_number": "312-761-4707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGLEY",
        "first_name": "LAFAYETTE",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-02",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.026408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.