Johnny White, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14900674 Issued in IL

Practice address

15663 Kimbark Ave
South Holland, IL 60473-1826

Phone

(630) 747-4498

NPI assigned

Dec 10, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Clinical Social Worker

Education

Other, 1993

Medicare assignment

May accept Medicare assignment

Group practices

Sondermind PCGroup PAC ID 0547795791, 64 clinicians

Christian Community Health CenterGroup PAC ID 4284533183, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: johnny.white.1@14868.direct.athenahealth.com

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.

• Christian Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1790888238
  Medicare reassignment Care Compare group NPD
• Sondermind PC

  • Clinical Social Worker
  • San Jose, CA
  • NPI 1003646977

  IL

  Medicare reassignment Care Compare group NPD
• Victory Mental Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tinley Park, IL
  • NPI 1629870506
  Medicare reassignment NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  IL

  Medicare reassignment NPD
• Hue Man Service Counseling & Consulting

  • Clinical Social Worker
  • South Holland, IL
  • NPI 1396499422
  NPD Authorized official
• Lifecore Rehab and Counseling Services SC

  • Mental Health Counselor
  • Orland Park, IL
  • NPI 1679819734
  Medicare reassignment
• First Life Behavioral Health Inc.

  • Clinical Social Worker
  • South Holland, IL
  • NPI 1598835431
  NPD (past) Authorized official
• First Life Behavioral Health LTD.

  • Community/Behavioral Health Agency
  • South Holland, IL
  • NPI 1396919460
  NPD (past) Authorized official
• Hue Man Service Counseling and Consulting

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1073941233
  NPD (past) Authorized official
• Christian Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Lansing, IL
  • NPI 1750619680
  NPD
• Christian Community Health Center

  • Federally Qualified Health Center (FQHC)
  • South Holland, IL
  • NPI 1912170457
  NPD
• 1 Care Inc.

  • General Practice Physician
  • Chicago, IL
  • NPI 1942649421
  NPD (past)

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

{
    "created_epoch": "1291939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291939200000",
    "number": "1306149497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15663 KIMBARK AVE",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731826",
            "telephone_number": "630-747-4498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15663 KIMBARK AVE",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731826",
            "telephone_number": "630-747-4498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "JOHNNY",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-12-10",
        "last_updated": "2010-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "14900674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED CLINICAL SOCIAL WORKER",
            "identifier": "14900674",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea I Washington
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• Angella Webb, RN, MSN, FNP-BC
• Amanda L Wengert, PT
• Wendell A Wheeler, M.D.
• Jonathan Ethan White, COTA
• Chrystal Whitfield
• Roshann Whitfield, HAIR LOSS SPECIALIST
• Wholebody Visiting Physicians
• Jennifer Wikel, M.A. CCC-SLP

• Clinical Social Worker in South Holland, IL
• Providers in South Holland, 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 Dec 10, 2010; 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.