Tiffany Nicole Shurtz, MSW, LCSW
Individual provider Active NPI Clinical Social Worker · Du Quin, IL
NPI 1467112417 · NPPES record last updated Jun 7, 2022
Key facts
- NPI
- 1467112417
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149023877 (IL)
- Practice address
- 119 Gas Plant Rd
Du Quin, IL 62832-3866 - Phone
- (618) 790-2146
- Fax
- (618) 790-2147
- NPI assigned
- Dec 17, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dynamic Counseling and Consultation Services
Practice addresses (Care Compare)
3 Cusumano Professional Plaza Dr
Suite B
Mount Vernon, IL 62864-6736
Phone (618) 816-1224
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220221000700 | IL | Practitioner - Clinical Social Worker | 6002200888 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dynamic Counseling and Consultation Services | Clinical | Current |
Accepting new patients |
Locations
3 Cusumano Professional Plaza Dr
#B
Mount Vernon, IL 62864
Phone (618) 316-7080
1111 S Lincoln Ave
Unit 1326
O Fallon, IL 62269
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149023877 | IL | Yes |
Addresses
Primary practice location
119 Gas Plant Rd
Du Quin, IL 62832-3866
Mailing address
PO Box 155
Christopher, IL 62822-0155
Phone (618) 724-1633
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.