Individual provider Active NPI

Kristen Angela Melchiori, MSW, CADC

  • Clinical Social Worker
  • Dekalb, IL
National Provider Identifier
1295259059
Registry record updated Nov 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.021903 Issued in IL
Practice address
631 S 1St St
Dekalb, IL 60115-4117
Phone
(815) 756-8501
Fax
(815) 756-5849
NPI assigned
Aug 2, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X 149.021903 IL Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 31825 IL

Addresses

Primary practice location

631 S 1St St
Dekalb, IL 60115-4117

Mailing address

631 S 1St St
Dekalb, IL 60115-4117
Phone (815) 756-8501

Other names 1

  • Kristen Angela Porzel Former name

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
I20200108002356 IL Practitioner - Clinical Social Worker 4284069816 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

900 E Diehl Rd
Suite 101
Naperville, IL 60563-2394
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31825ILMDAddiction (Substance Use Disorder) Counselor
149.021903ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. Mental Health CurrentSince Sep 1, 2023 Accepting new patients
Psychology Specialists LTD Clinical Past Accepting new patients

Locations

808 S Eldorado Rd
Ste 102
Bloomington, IL 61704
Phone (309) 212-6007

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

900 E Diehl Rd
Ste 101
Naperville, IL 60563
Phone (630) 328-0134

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730505600000",
    "number": "1295259059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 S 1ST ST",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601154117",
            "telephone_number": "815-756-8501",
            "fax_number": "815-756-5849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 S 1ST ST",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601154117",
            "telephone_number": "815-756-8501",
            "fax_number": "815-756-5849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELCHIORI",
        "first_name": "KRISTEN",
        "middle_name": "ANGELA",
        "credential": "MSW, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-02",
        "last_updated": "2024-11-02",
        "certification_date": "2024-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.021903",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "31825",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "PORZEL",
            "middle_name": "ANGELA",
            "credential": "CADC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dekalb, IL

Sources for this page

Verify at the official NPI Registry.