NPIMap

Individual provider Active NPI

Lauren D Boucek, LCSW

  • Clinical Social Worker
  • Champaign, IL
National Provider Identifier
1487719191
Registry record updated Nov 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149016829 Issued in IL
Practice address
1813 W. Kirby Ave
Champaign, IL 61821-5410
Phone
(217) 383-1850
Fax
(217) 383-3439
NPI assigned
Dec 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 23179 CA
Clinical Social Worker 1041C0700X 149016829 IL Primary

Addresses

Primary practice location

1813 W. Kirby Ave
Champaign, IL 61821-5410

Mailing address

611 W. Park St.
BWPC
Urbana, IL 61801-2500
Phone (217) 383-6792

Other identifiers 1

IdentifierTypeStateIssuer
LCSW23179OtherCALICENSE CLINICAL SOCIAL W

Other names 1

  • Lauren D. Gross Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149016829ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Jewish Family Service of San Diego PastSince Dec 12, 2006 Accepting new patients
Carle Health Care Incorporated PastSince Oct 20, 2014 Accepting new patients

Organizations & group practices 2

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": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415318400000",
    "number": "1487719191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W. PARK ST.",
            "address_2": "BWPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012500",
            "telephone_number": "217-383-6792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 W. KIRBY AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215410",
            "telephone_number": "217-383-1850",
            "fax_number": "217-383-3439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCEK",
        "first_name": "LAUREN",
        "middle_name": "D",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-22",
        "last_updated": "2014-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "23179",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149016829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE CLINICAL SOCIAL W",
            "identifier": "LCSW23179",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAUREN",
            "last_name": "GROSS",
            "middle_name": "D.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.