Individual provider Active NPI

Jason Thomas Davis, MA, LPC

  • Professional Counselor
  • Evanston, IL
National Provider Identifier
1356870927
Registry record updated Jun 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
2530 Crawford Ave Ste 208
Evanston, IL 60201-4959
Phone
(224) 688-2277
NPI assigned
Jun 7, 2017
Last updated
Jun 7, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X IL Primary

Addresses

Primary practice location

2530 Crawford Ave Ste 208
Evanston, IL 60201-4959

Mailing address

2530 Crawford Ave Ste 208
Evanston, IL 60201-4959
Phone (224) 688-2277

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
I20231219002418 IL Practitioner - Mental Health Counselor 3274983135 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
May accept Medicare assignment
Group practices
Lisa Schwab, LLCGroup PAC ID 1850688557, 5 clinicians

Practice addresses (Care Compare)

4211 N Prospect Rd
Peoria Heights, IL 61616-7754
Phone (309) 691-5502

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Lisa Schwab, LLC Professional CurrentSince Jan 1, 2024 Accepting new patients

Locations

4211 N Prospect Rd
Peoria Hts, IL 61616
Phone (309) 691-5502

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496793600000",
    "number": "1356870927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 CRAWFORD AVE STE 208",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014959",
            "telephone_number": "224-688-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CRAWFORD AVE STE 208",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014959",
            "telephone_number": "224-688-2277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JASON",
        "middle_name": "THOMAS",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-07",
        "last_updated": "2017-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.