Individual provider Active NPI

Kimberly A Koralewski, LCSW, CADC

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1316485113
Registry record updated Apr 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149-011365 Issued in IL
Practice address
2020 W Harrison St
Chicago, IL 60612-3741
Phone
(312) 572-4879
NPI assigned
Feb 1, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 32366 IL
Mental Health Counselor 101YM0800X 149.011365 IL
Clinical Social Worker 1041C0700X 149-011365 IL Primary

Addresses

Primary practice location

2020 W Harrison St
Chicago, IL 60612-3741

Mailing address

2020 W Harrison St
Chicago, IL 60612-3741
Phone (312) 572-4879

Other names 1

  • Ms. Kimberly A Wiater Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kwiater@direct.ccprovider.org Direct Cook County

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
I20200605001366 IL Practitioner - Clinical Social Worker 3971924507 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
95.11 of 100Reported as group
Quality
74.7
Promoting interoperability
100
Improvement activities
40
Cost
85.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
32366ILMDAddiction (Substance Use Disorder) Counselor
149.011365ILMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County CurrentSince May 22, 2020 Accepting new patients
Cook County Current Accepting new patients
Cook County CurrentSince May 22, 2020 Accepting new patients
Psychotherapy Associates of Chicago Clinical Past Accepting new patients

Locations

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

2020 W Harrison St
Chicago, IL 60612
Phone (312) 572-4500

1969 W Ogden Ave
Chicago, IL 60612
Phone (312) 864-3600

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

Interoperability endpoints

  • Direct secure messaging: kwiater@direct.ccprovider.org

Organizations & group practices 4

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": "1485907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1316485113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123741",
            "telephone_number": "312-572-4879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123741",
            "telephone_number": "312-572-4879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORALEWSKI",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "LCSW, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-01",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "32366",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "149.011365",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-011365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwiater@direct.ccprovider.org",
            "affiliation": "Y",
            "affiliationName": "Cook County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1969 W. Ogden Ave.",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606123723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "WIATER",
            "middle_name": "A",
            "prefix": "MS.",
            "credential": "LCSW, CADC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.