Individual provider Active NPI

Mary Josie Klass, LCSW

  • Clinical Social Worker
  • San Antonio, TX
National Provider Identifier
1386236271
Registry record updated Feb 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149020199 Issued in IL
Practice address
7272 Wurzbach Rd Ste 601
San Antonio, TX 78240-4803
Phone
(210) 615-3483
NPI assigned
Feb 11, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149020199 IL Primary

Addresses

Primary practice location

7272 Wurzbach Rd Ste 601
San Antonio, TX 78240-4803

Mailing address

1107 E Hickory St
Streator, IL 61364-2449
Phone (210) 615-3483

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
I20210224000380 IL Practitioner - Clinical Social Worker 8123433232 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Illinois Valley Counseling ServicesGroup PAC ID 0244467066, 8 clinicians

Practice addresses (Care Compare)

747 E Etna Rd
B
Ottawa, IL 61350-3777
Phone (815) 993-1614

Merit-based Incentive Payment System (MIPS)

Final score
91.66 of 100Reported as group
Quality
80.64
Improvement activities
40
Cost
74.35

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149020199ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Valley Counseling Services Clinical CurrentSince Jun 10, 2023 Accepting new patients

Locations

901 Main St
Ste A
Mendota, IL 61342
Phone (815) 538-7300

747 E Etna Rd
#B
Ottawa, IL 61350
Phone (815) 993-1614

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": "1613001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613001600000",
    "number": "1386236271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 E HICKORY ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642449",
            "telephone_number": "210-615-3483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7272 WURZBACH RD STE 601",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782404803",
            "telephone_number": "210-615-3483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLASS",
        "first_name": "MARY",
        "middle_name": "JOSIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-11",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149020199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.