Active NPI
David Fries
- Clinical Social Worker
- Waukegan, IL
National Provider Identifier
1386091965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.006690
- Practice address
- 671 S Lewis Ave
Waukegan, IL 60085-6101 - Phone
- (847) 782-4130
- Fax
- (847) 782-1030
- NPI assigned
- May 24, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.006690 | IL | Primary |
Addresses
Primary practice location
671 S Lewis Ave
Waukegan, IL 60085-6101
Mailing address
671 S Lewis Ave
Waukegan, IL 60085-6101
Phone (847) 782-4130
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669583001 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.006690 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peoples Therapy of Chicago PLLC | Clinical | Past | Accepting new patients |
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.
-
- Clinical Social Worker
- Chicago, IL
- NPI 1942938857
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464048000000",
"number": "1386091965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "671 S LEWIS AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600856101",
"telephone_number": "847-782-4130",
"fax_number": "847-782-1030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "671 S LEWIS AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600856101",
"telephone_number": "847-782-4130",
"fax_number": "847-782-1030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRIES",
"first_name": "DAVID",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-24",
"last_updated": "2016-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.006690",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1669583001",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.