Kenneth Simpson Sr., LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.021624 Issued in IL

Practice address

4747 Lincoln Mall Dr Ste 412
Matteson, IL 60443-3821

Phone

(708) 300-6977

Fax

(708) 300-6978

NPI assigned

May 11, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenneth.simpson.1@13826.direct.athenahealth.com

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.

• One Direction Forward Inc.

  • Community/Behavioral Health Agency
  • Matteson, IL
  • NPI 1215392931
  NPD Authorized official
• One Direction Forward Inc.

  • Adult Mental Health Clinic/Center
  • Matteson, IL
  • NPI 1982340220
  NPD Authorized official
• Metro Treatment of Gary LP

  • Methadone Clinic
  • Gary, IN
  • NPI 1841412996
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649462400000",
    "number": "1477089290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4747 LINCOLN MALL DR STE 412",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604433821",
            "telephone_number": "708-300-6977",
            "fax_number": "708-300-6978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 LINCOLN MALL DR STE 412",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604433821",
            "telephone_number": "708-300-6977",
            "fax_number": "708-300-6978"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8000 Melton Rd",
            "address_purpose": "LOCATION",
            "city": "Gary",
            "state": "IN",
            "postal_code": "464033114",
            "country_code": "US",
            "telephone_number": "219-938-4651",
            "fax_number": "219-938-4679",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMPSON",
        "first_name": "KENNETH",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-11",
        "last_updated": "2022-04-09",
        "certification_date": "2022-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "23393",
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "IL",
            "license": "22083",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.021624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447089290",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alan B Shnay, O.D.
• Sandra Shufford
• Alicia Jocelyn Simmons, LCPC
• Simple Sticks Laboratory
• Simplifycare Inc
• Blythe Hilary Smith, LCPC
• Miah Raven Symone Smith
• Tiffani Smith, LPC
• Victoria B Smith
• Karen A Sobieraj, MSW LCSW BCD

• Clinical Social Worker in Matteson, IL
• Providers in Matteson, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.