Individual provider Active NPI

Sondra Lynn Wise, LSW

  • Clinical Social Worker
  • Springfield, IL
National Provider Identifier
1417047168
Registry record updated Oct 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149013262 Issued in IL
Practice address
710 N 8TH St
Springfield, IL 62702-6324
Phone
(217) 525-1064
Fax
(217) 525-1651
NPI assigned
Oct 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2008

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 149013262 IL Primary

Addresses

Primary practice location

710 N 8TH St
Springfield, IL 62702-6324

Mailing address

710 N 8TH St
Springfield, IL 62702-6324
Phone (217) 525-1064

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
I20090102000332 IL Practitioner - Clinical Social Worker 9335201169 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mental Health Centers of Central IllinoisGroup PAC ID 8325940521, 18 clinicians

Practice addresses (Care Compare)

710 N 8TH St
Springfield, IL 62702-6324
Phone (217) 525-1064

901 N 1St St
Suite 225
Springfield, IL 62702-3760
Phone (217) 788-4065

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mental Health Centers of Central Illinois CurrentSince Sep 24, 2008 Accepting new patients
Memorial Health Partners Current Accepting new patients
Mental Health Centers of Central Illinois Clinical CurrentSince Apr 13, 2019 Accepting new patients
Springfield Clinic LLP Current Accepting new patients

Locations

3225 Hedley Rd
Springfield, IL 62711
Phone (217) 726-6700

901 N 1st St
Ste 225
Springfield, IL 62702
Phone (217) 523-2217

Interoperability endpoints

  • Direct secure messaging: sondrawise@memorial.allscriptsdirect.net
  • Direct secure messaging: sondrawise@sfc.allscriptsdirect.net

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": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223510400000",
    "number": "1417047168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N 8TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627026324",
            "telephone_number": "217-525-1064",
            "fax_number": "217-525-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N 8TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627026324",
            "telephone_number": "217-525-1064",
            "fax_number": "217-525-1651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "SONDRA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2008-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149013262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.