Individual provider Active NPI

Stacy A Kissamis, LCSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1437935699
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.021599 Issued in IL
Practice address
200 N. Lasalle Street
Chicago, IL 60601
Phone
(888) 660-4425
NPI assigned
Sep 5, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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 149.021599 IL Primary

Addresses

Primary practice location

200 N. Lasalle Street
Chicago, IL 60601

Mailing address

605 Academy CT
Schaumburg, IL 60194-2501
Phone (630) 432-7044

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
I20230929000597 IL Practitioner - Clinical Social Worker 1355795063 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Post Acute Care PLLCGroup PAC ID 0143547117, 125 clinicians

Practice addresses (Care Compare)

1001 E Pells St
Paxton, IL 60957-1300
Phone (888) 705-8722

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.021599ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Post Acute Care PLLC Clinical CurrentSince Sep 1, 2023 Accepting new patients

Locations

2045 W Grand Ave
Ste B
Chicago, IL 60612
Phone (800) 827-7437

1001 E Pells St
Paxton, IL 60957
Phone (217) 379-4361

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": "1693872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1437935699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 ACADEMY CT",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601942501",
            "telephone_number": "630-432-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N. LASALLE STREET",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60601",
            "telephone_number": "888-660-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISSAMIS",
        "first_name": "STACY",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-05",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.021599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.