Individual provider Active NPI

Patricia J Edwards, LCSW

  • Social Worker
  • Peoria, IL
National Provider Identifier
1356444913
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
149002553 Issued in IL
Practice address
6615 N Big Hollow Rd
Peoria, IL 61615-2451
Phone
(309) 692-6622
Fax
(309) 692-6952
NPI assigned
Sep 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 149002553 IL Primary

Addresses

Primary practice location

6615 N Big Hollow Rd
Peoria, IL 61615-2451

Mailing address

6615 N Big Hollow Rd
Peoria, IL 61615-2451
Phone (309) 692-6622

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
I20040329000832 IL Practitioner - Clinical Social Worker 5092607580 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Antioch Group IncGroup PAC ID 8224920764, 8 clinicians

Practice addresses (Care Compare)

6615 N Big Hollow Rd
Peoria, IL 61615-2450
Phone (309) 692-6622

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149002553ILMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Antioch Group, Inc. CurrentSince Nov 1, 2003 Accepting new patients

Locations

6615 N Big Hollow Rd
Peoria, IL 61615
Phone (309) 691-5200

Organizations & group practices 1

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": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1356444913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6615 N BIG HOLLOW RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152451",
            "telephone_number": "309-692-6622",
            "fax_number": "309-692-6952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 N BIG HOLLOW RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152451",
            "telephone_number": "309-692-6622",
            "fax_number": "309-692-6952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "PATRICIA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-07",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "149002553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.