Diane Petersen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.005019 Issued in IL

Practice address

18640 W Il Route 120
Grayslake, IL 60030-9733

Phone

(847) 548-6000

Fax

(847) 548-6040

NPI assigned

Mar 5, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Loyola University of Chicago, Stritch School of Medicine, 1971

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

B and B Spaulding LLCGroup PAC ID 7810177177, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• B & B Spaulding LLC

  • Community/Behavioral Health Agency
  • Deer Park, IL
  • NPI 1902106750
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1362441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362441600000",
    "number": "1306187117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18640 W IL ROUTE 120",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600309733",
            "telephone_number": "847-548-6000",
            "fax_number": "847-548-6040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18640 W IL ROUTE 120",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600309733",
            "telephone_number": "847-548-6000",
            "fax_number": "847-548-6040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "DIANE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-05",
        "last_updated": "2013-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.005019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sierra Rose Patino
• Pediatric Interactions
• Pediatric Interactions Inc
• Eva Elita Perez, DNP
• Leslie Perez
• Amanda Pfeiffer
• Cassidy Veronica Phagan, DDS
• Alain Pierre-Louis, MD, MA
• Pignone Investment Group Inc
• Michael J. Pinkowski, PH.D.

• Clinical Social Worker in Grayslake, IL
• Providers in Grayslake, 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 Mar 5, 2013; 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.